Crack Cocaine Use Research Articles

Crack cocaine use frequency is associated with HIV disease severity independent of antiretroviral therapy exposure: a prospective cohort study.

We sought to evaluate the effect of crack cocaine use frequency on HIV disease severity among HIV-positive people who use unregulated drugs (PWUD). We analyzed data from the ACCESS study, an open prospective cohort of HIV-positive PWUD including comprehensive HIV clinical monitoring in a setting with no-cost healthcare. Multivariable generalized linear mixed-effects models were used to estimate the independent effect of time-updated crack cocaine use frequency on HIV disease severity, adjusting for ART exposure and relevant confounders. In multivariable adjusted models, daily or greater frequency of crack cocaine use was significantly associated with higher VACS Index scores (β = 0.8, 95% confidence interval: 0.1, 1.5) as compared to none. Our finding suggests that daily or greater frequency of crack cocaine use exacerbates HIV disease severity independent of ART exposure. The observed effect may reflect an underlying biological mechanism or other factors linked with crack cocaine use; further investigation is warranted.

Lung Transplantation from Donors with a History of Substance Use

<h3>Purpose</h3> Substance use is common among lung transplant donors, but the implications have not been well studied aside from donor smoking. Stimulant drugs such as cocaine and methamphetamine can induce pulmonary arterial hypertension while smoked products such as cannabis and crack cocaine can produce airways and parenchymal lung diseases. We sought to characterize donor substance use at our center and evaluate the associations with overall survival as well as post-transplant graft function. <h3>Methods</h3> We studied all double lung transplants in our program between 2004-2016. We reviewed donor substance use histories for the following: heavy smoking, heavy drinking, regular cannabis smoking, ecstasy, benzodiazepines, cocaine, crack cocaine, methamphetamine, crystal methamphetamine, and opiates. We used proportional hazards modelling to evaluate the association between each drug and overall survival as well as chronic lung allograft dysfunction (CLAD) development. We used Fisher's Exact test to evaluate the association between drug use and grade 3 primary graft dysfunction (PGD3) in addition to baseline lung allograft dysfunction (BLAD), defined as failure to achieve both FEV1 and FVC ≥80% predicted on 2 consecutive tests ≥3 weeks apart. <h3>Results</h3> Of 473 recipients studied, 186 (39%) received lungs from a donor with a history of drug use in at least one of the 9 categories defined previously. Donor heavy smoking (n=65) was associated with lower overall survival (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.03-2.10; p=0.032) and an increased risk of PGD3 (odds ratio [OR]: 2.13; 95% CI: 1.15-3.84; p=0.014) and BLAD (OR: 2.56; 95% CI: 1.47-4.53; p<0.001). Donor crack cocaine use (n=24) was also associated with impaired overall survival both unadjusted (HR: 2.02; 95% CI: 1.15-3.55; p=0.015) and adjusted for donor heavy smoking (HR: 1.99; 95% CI: 1.13-3.50; p=0.017). No other history of donor substance use was associated with post-transplant survival, CLAD, PGD3, or BLAD. <h3>Conclusion</h3> History of substance use was common in our cohort of lung donors. Donor crack cocaine use in addition to donor heavy smoking were associated with impaired post-transplant survival while donor use of other substances does not appear to affect survival and lung function outcomes post-transplant.

Sociodemographic and clinical profile of crack cocaine treatment-seeking individuals living in “Crackland”, Brazil

ABSTRACT Objective: São Paulo‘s Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. Methods: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. Results: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. Conclusion: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.

Gender differences in progression to crack-cocaine use and the role of sexual and physical violence.

Objective:This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression.Methods:We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use.Results:Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01).Conclusions:We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics.

Tina's ParTy line: Polysubstance use patterns in sexual minority men living with HIV who use methamphetamine.

This cross-sectional study examined the associations of demographic, structural and psychological factors with distinct typologies of polysubstance use in sexual minority men (SMM) living with HIV who use methamphetamine. In total, 161 SMM living with HIV who reported methamphetamine use in the past 3 months were recruited in San Francisco from 2013 to 2017 for a randomised controlled trial. A latent class analysis was conducted by leveraging baseline measures of self-reported use of 15 substances in the past 3 months as well as validated screening measures of hazardous alcohol and cannabis use. Correlates of latent class membership were examined using a three-step categorical latent variable logistic regression. Four typologies of substance use were identified: (i) methamphetamine use only (43%); (ii) methamphetamine and crack-cocaine use (22%); (iii) party and play use-methamphetamine, gamma-hydroxybutyrate and amyl nitrites (i.e. poppers) with erectile dysfunction drugs (31%); and (iv) high polysubstance use (4%). SMM of colour and those with a history of incarceration were more commonly classified as engaging in methamphetamine and crack-cocaine use compared to party and play use. Men with higher sexual compulsivity scores were more commonly classified as engaging in party and play use and polysubstance use. There is substantial heterogeneity in polysubstance use patterns among SMM living with HIV who use methamphetamine. This will inform the development of tailored substance use interventions addressing the unique needs of SMM of colour and targeting sexual compulsivity as a prominent comorbidity for some men.

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.

Associations amongst form of cocaine used (powder vs crack vs both) and HIV-related outcomes

IntroductionCocaine (including powder and crack) use is common among people with HIV (PWH). We identified socio-demographic and behavioral factors associated with cocaine use (overall and various forms) among PWH; we also examined differences in HIV treatment outcomes across cocaine exposure groups. MethodsThe study sample (N = 1166) was derived from two cohorts of PWH in Florida between 2014 and 2020. Baseline data were linked to the Enhanced HIV/AIDS Reporting System (eHARS) which tracks HIV viral load. Socio-demographics and polysubstance use were compared by cocaine use and the three cocaine use groups (powder only n = 101, crack only n = 91, or both n = 65). The association between the three cocaine use groups, ART adherence, and HIV viral suppression (<200 copies/mL) in the following year was assessed by multivariate logistic regression. ResultsPeople who used cocaine had lower HIV treatment adherence and viral suppression than those who did not use. People who used powder cocaine only were more likely to be younger, Hispanic/Latinx, and employed than those who used crack only or both. Compared to people who used both powder and crack cocaine, those who used one form of cocaine had 3 + odds of having durable viral suppression in the following year. ConclusionThe dual use of both powder and crack cocaine was associated with significantly worse HIV outcomes compared to use of only one form of cocaine. Screening for powder and crack cocaine use and timely intervention are needed to improve HIV treatment outcomes among this high-risk population.

Association between alcohol and crack: Prevalence, effects, associated factors and experiences of combined use.

ObjectiveTo estimate the prevalence and factors associated with the effect of alcohol on crack cocaine use and to analyze experiences related to combined use. Materials and methods: sequential mixed methods (qualitative and quantitative) research, carried out between August 2014 and August 2015 with people who use crack. In the quantitative approach, a cross-sectional study was conducted with 1,062 participants. Factors associated with “alcohol use with the effect of increasing the effect of crack/crack craving” were estimated by multiple regression. In the qualitative approach, 39 interviews were conducted using Bardin’s content analysis technique.Results871 (82.0%) participants reported consuming alcohol, among them, 668 (76.7%) used alcohol combined with crack: 219 (32.8%) reported feeling an effect of reduction in paranoia and/or crack craving and 384 (57.5%) reported feeling an increase in the effect of crack and in the craving to consume the drug. This relationship was also observed in the narratives of the people who use crack, with the possibility of a cyclic effect of consumption of the two substances. Those who related alcohol use to the effect of increasing crack craving (384) were more likely to use alcohol before crack (OR: 1.81; 95%CI: 1.13–2.89); to consume more than 20 stones daily (OR: 1.48; 95%CI: 1.01–2.16); to remain in abstinence from crack for less than one month (OR: 3.20; 95%CI: 1.91–5.35); to use dependence treatment services (OR: 1.85; 95%CI: 1.26–2.71); and to commit physical violence (OR:1.67; 95%CI:1.08–2.56).ConclusionThe findings of this study indicate that the modulation of the effect of alcohol use on crack cocaine depends on the moment when the drugs are consumed, and the use of alcohol before crack consumption is associated with characteristics that suggest a greater vulnerability to patterns of harmful crack use. Even though combined use is referred to as a way of reducing the negative effects of crack, the damage of this association may be greater than its possible benefits.

Prevalence of crack cocaine use and its associated factors in patients treated in a specialized outpatient service

Abstract Background Despite the advance in studies addressing the use of crack cocaine, knowledge about the characteristics of users that seek treatment in the different modalities of care for substance use disorders is important to plan the operationalization of these services. Objective To analyze the prevalence and factors associated with the use of crack cocaine in outpatients. Method Cross-sectional study consisting in the analysis of the medical records of outpatients of a chemical dependency clinic located in the south of Brazil from 1999 to 2015. The Fisher’s exact test and the Poisson regression model were used to analyze the data. Results Medical records from 1,253 patients were analyzed, and 1,196 (95.5%) of them contained information on the use of crack cocaine. Use of this substance was reported by 47% (95% CI [44, 50]) of the outpatients. The risk group was composed of adults aged 20-39 years, with no income, who had three or more children, did not consume alcohol or marijuana, had continuous family assistance, spontaneously looked for the service, and had already been hospitalized or assisted at a therapeutic community or psychosocial center. Conclusion There is great demand for the outpatient care of crack cocaine users. It is crucial that the risk factors guide treatment planning.

27736 Painful retiform purpura with cutaneous necrosis

A 46-year-old Caucasian male with a past medical history significant for hepatitis C virus (HCV) infection, metastatic melanoma, and years of crack cocaine use presented to the emergency department with a one-week history of painful lesions involving the nose, limbs, and mouth. Skin exam showed painful purpura of the ears and right nasal ala, retiform purpura with necrosis of all four extremities, and an ulcer of the left buccal mucosa. His initial laboratory values were significant for microcytic anemia, decreased complement levels, and a positive drug screen for cocaine.

Association between crack cocaine use and dental caries experience: a cross-sectional study in southern Brazil.

The aim of the present study was to compare the prevalence of dental caries between crack cocaine users and a control group. The study included 106 participants in each group matched for age, sex, and exposure to tobacco. Crack cocaine users were selected from institutions for the treatment of chemical dependency, and the control group was recruited from a public school and among patients who sought dental care. A calibrated examiner determined dental caries experience [Decayed, Missing and Filled Teeth (DMFT) index]. The severity of tooth decay was determined using the Significant Caries Index (SiC). The prevalence of dental caries (DMFT ≥ 1) was 96.2 and 81.1% among the crack cocaine users and nonusers, respectively. Crack users had higher mean DMFT values (7.16 versus 4.92) for the decayed and missing components as well as a higher percentage of individuals with highly severe caries compared to nonusers. After the adjustments in the multivariate model, the prevalence of caries was 18% higher among the crack users (prevalence ratio: 1.18; 95% confidence interval: 1.08-1.30). Age, family income, crack cocaine use, and dental calculus were associated with the occurrence of dental caries. In conclusion, the prevalence of caries was higher among the crack users compared with the control group and remained associated with dental caries in the multivariate analysis.

Parrot Beak Nail: Case Report and Review of Parrot Beak Nail Dystrophy

Parrot beak nail dystrophy is an excessive forward curvature of the nail plate that can affect both fingernails and toenails. Few cases have been reported since its original description in 1971; however, the incidence is estimated to be 2.5% in healthy individuals. Although the pathogenesis has not yet been established, parrot beak nail has been associated with chronic crack cocaine use, congenital bone or soft tissue abnormalities, other nail dystrophies, peripheral neuropathy, systemic sclerosis, and trauma to the nail. We describe an 86-year-old man with dementia and neuropathy who presented with an unperceived parrot beak nail of his left fourth toenail and concurrent onycholysis of his left great toenail. He had stopped visits with his podiatrist for nail care, which fostered the growth of these nail dystrophies. Our patient’s parrot beak nail was successfully treated with nail clipping and regular nail maintenance to prevent its recurrence. The associated conditions, etiologies, and treatment of parrot beak nails are discussed.

Crack cocaine use among aging Mexican American men with heroin use histories: motivations and polydrug use patterns

Background Knowledge about the motivations for crack cocaine use and the long-term effects among people who inject heroin is limited. This study aims to understand motivations associated with this co-use drug pattern among aging men entrenched in established intergenerational heroin subcultures. Methods: A sample of 60 men with diverse injecting heroin use histories was recruited from low-income Mexican American urban communities for semi-structured ethnographic interviews using respondent-driven sampling. Qualitative analysis was then employed to provide an in-depth understanding of patterns and motivations of polydrug use among this older population. Results: The men discussed motivations including tolerance, curiosity and experimentation, a paradox of affordability, alternatives to the health hassles and stigma, and the cross-fertilization of drug markets. Concurrent and switching use patterns were primarily reported among those seeking a new or different high, while replacement patterns were reported by men in methadone treatment or by those who had tired of injection. Discussion: Findings translate to the on-going opioid crisis and the emerging trend in polysubstance use involving crack cocaine, methamphetamine and other psychostimulants among people who use heroin. More research is needed to investigate the full range of social and health consequences associated with these co-use patterns. Targeted and tailored prevention and treatment services are essential to improve outcomes among aging Mexican American men who use heroin and other persons with similar polydrug use patterns.

Oxytocin Receptor Exon III Methylation in the Umbilical Cord Blood of Newborns With Prenatal Exposure to Crack Cocaine.

BackgroundPrenatal cocaine exposure (PCE) is associated with behavioral, cognitive, and social consequences in children that might persist into later development. However, there are still few data concerning epigenetic mechanisms associated with the effects of gestational cocaine exposure, particularly in human newborns.AimsWe investigated the effects of PCE on DNA methylation patterns of the Oxytocin Receptor (OXTR) gene in the umbilical cord blood (UCB). The relationship between UCB DNA methylation levels and the severity of the mother’s cocaine use during pregnancy was also evaluated.MethodsIn this cross-sectional study, 28 UCB samples of newborns with a history of crack cocaine exposure in utero and 30 UCB samples of non-exposed newborns (NEC) were compared for DNA methylation levels at two genomic loci located in exon III of the OXTR gene (OXTR1 and OXTR2) through pyrosequencing. Maternal psychopathology was investigated using the Mini International Neuropsychiatric Interview, and substance use characteristics and addiction severity were assessed using the Smoking and Substance Involvement Screening Test (ASSIST).ResultsNo differences between newborns with a history of PCE and NEC were observed in OXTR1 or OXTR2 DNA methylation levels. However, regression analyses showed that maternal addiction severity for crack cocaine use predicted OXTR1 DNA methylation in newborns.ConclusionThese data suggest that OXTR methylation levels in the UCB of children are affected by the severity of maternal crack cocaine usage. Larger studies are likely to detect specific changes in DNA methylation relevant to the consequences of PCE.

Prevalence of pulmonary disease in alcohol and poly substance abuse

AimsThe aim of this study is to identify the prevalence of pulmonary disease or progression of symptoms which can lead to respiratory disease in substance misuse. Identify risk: prescribe a safer substitute treatment (Methadone vs Buprenorphine). Identify combination of different drugs, causing toxicity and damage to lungs.BackgroundSmoking and illicit substance misuse is recognized as a cause of pulmonary diseaseMethodThe study was conducted in 2015 at outpatient addictions service (CAPS/CDC 69 Warwick Road London SW5 9HB). All 50-participants gave consent and data were collected including demographic details, history of substance abuse, route of administration, medical history, Peak Expiratory Flow rate (PEFR). A questionnaire was designed to assess the severity of shortness of breath (SOB), with or without exertion to ascertain the extent of the disease.Conclusion14 males and 3 females achieved 31 to 48.9 % of predicted PEFR. 13 males and 7 females achieved 51.1 to 69.6% of predicted PEFR. 7 males and 2 females achieved 70.8 to 91.1% of predicted PEFR. 2 males and 2 females achieved 100 to 114.3% of predicted PEFR. From the questionnaire on SOB with or without exertion, 8 males and 2 females reported moderate to severe shortness of breath on minimum exertion. 33 males and 11 females reported variable degree of SOB. 4 males and 2 females did not report SOB on reasonable exertion. 23 males and 10 females reported variable degree of SOB at rest, 14 males and 3 females reported no SOB at rest. 34 participants were receiving OST with methadone, 16 were on Buprenorphine. 6 patient treatments were switched to Buprenorphine due to Exacerbated COPD. 47 patients reported using Tobacco from harmful to dependent use. 44 patients reported harmful to dependent use of crack cocaine. 34 patients fulfilled the criteria of harmful use of cannabinoids. 33 patients were diagnosed with harmful to dependent use of alcohol. 10 patients reported heavy use of solvents. 2 patients reported harmful use of Party drugs. Many patients reported a history of recurrent chest infections 3-6 times a year, Asthma, COPD, Emphysema, Pneumonia and 2 were treated for Tuberculosis. 1/3 patients have a diagnosis of hypertension and IHD, liver disease and portal hypertension

Hepatitis E Virus in People Who Use Crack-Cocaine: A Cross-Sectional Study in a Remote Region of Northern Brazil.

People who use crack-cocaine (PWUCC) have numerous vulnerabilities and pose a challenge to health and social assistance services. The exposure to pathogens and risk situations occur differently according to each individual, region and social group. This study identified the presence, genotypes and factors associated with hepatitis E virus (HEV) exposure among a community-recruited cohort of 437 PWUCC in northern Brazil. Epidemiological information was collected through community-based assessments and interviews. Thereafter, blood and fecal samples were collected and tested for HEV using an immunoenzymatic assay, and the genotype was identified by PCR. Logistic regressions were used to identify the risk factors independently associated with exposure to HEV. In total, 79 (18.1%) PWUCC were exposed to HEV: 73 (16.7%) for IgG and six for IgG + IgM. HEV RNA was detected in six fecal samples and in two blood samples from PWUCC with IgM + IgG. Subtype 3c was identified in all of the samples. The factors associated with exposure to HEV were low monthly income, unstable housing (e.g., homelessness), crack-cocaine use ≥40 months, and the shared use of crack-cocaine equipment. The current study provides unique initial insights into HEV status and risk factors among PWUCC in a remote area in Brazil, with diverse implications for urgently improved diagnosis, prevention, and treatment intervention needs.

Factors associated with methamphetamine withdrawal symptoms among people who inject drugs

BackgroundRegular methamphetamine (MA) use can result in withdrawal syndrome characterized by fatigue, agitation, depression, and anxiety. No studies that we are aware of have examined the prevalence and predictors of MA withdrawal symptoms among people who inject drugs (PWID). MethodsPWID were recruited using targeted sampling methods in Los Angeles and San Francisco, California from 2016 to 2017. Survey questions included demographics, drug use, and MA withdrawal symptoms, frequency, and symptom severity. Participants who reported regular MA use (> 12 times in the last 30 days) were included in this analysis (N = 595). Multivariable regression models were developed to examine factors associated with any MA withdrawal, withdrawal frequency, symptom severity, and receptive syringe sharing. ResultsMA withdrawal symptoms in the past 6 months were reported by 53 % of PWID, with 25 % reporting weekly withdrawal symptoms, and 20 % reporting very or extremely painful symptoms. In multivariable logistic regression, presence of any MA withdrawal symptoms was positively associated with more frequent MA use and non-injection tranquilizer use and inversely associated with crack cocaine use. Among those reporting any withdrawal, female sex was associated with more frequent withdrawal symptoms. Very or extremely painful withdrawal symptoms were associated with being in residential treatment. Receptive syringe sharing was associated with any MA withdrawal symptoms and weekly frequency of symptoms. ConclusionMA withdrawal symptoms are common among PWID and are associated with receptive syringe sharing. Strategies for implementing MA use treatment, safe supply programs, and syringe services programs targeting people who inject MA are indicated.

Application of the frailty framework among vulnerable populations to hospitalization outcomes of individuals experiencing homelessness in Long Beach, California

ABSTRACT Background: Individuals experiencing homelessness have a high prevalence of infectious diseases that may result in hospitalization. Objectives: This study uses risk factors at baseline to predict hospitalization at follow-up. This paper also presents the associations between reporting homelessness and selected infectious diseases. Research design: Longitudinal study of baseline and follow-up conducted August 2000 through July 2014. Subjects: 4916 Not experiencing homelessness mean age 37.9 years, 29% female, and 2692 experiencing homelessness age 42.1 years, 29% female received services from a research/service center in a low-income, high-crime area of Long Beach, CA. Measures: Risk Behavior Assessment, Risk Behavior Follow-up Assessment, laboratory testing for hepatitis A, hepatitis B, hepatitis C, syphilis, chlamydia, and gonorrhea. Results: Predictors of hospitalization at follow-up were ever use of crack cocaine, income from Social Security or disability, reporting homelessness, female, and those who identify as Black race/ethnicity. Conclusions: Income from the safety net of Social Security or disability provides participants with experience that transfers to being able to obtain healthcare. A higher proportion of those experiencing homelessness, compared to those not experiencing homelessness, appear to be hospitalized at follow-up. Our findings support use of the Frailty Framework when working with individuals experiencing both homelessness and hospitalization.

Impact of the COVID-19 pandemic in a substance use harm reduction setting

IntroductionHarm reduction (HR) approaches substance use disorders (SUDs) from a standpoint of humanism and tolerance, understanding the difficulty of terminating consumption in some cases, and instead promoting practices aimed at reducing risks inherent to substance use while granting accessibility to comunity based healthcare and contact with differentiated care, when needed, to patients who otherwise wouldn’t have access to it. The COVID-19 pandemic brought about an economic crises, impacting mainly people from lower classes, associated with an increased prevalence of heroine and crack cocaine use and exacerbating previous SUDs.ObjectivesDescribe changes in a HR population treated in HR context in Gaia, Portugal.MethodsData was retrieved from clinical files of patients undergoing treatment in a Harm Reduction setting on the HR team “GiruGaia” from Porto. Analysed data included number of patients admitted to treatment in the period between march the 1st and december the 30th 2020, their sociodemographic data, psychiatric and substance use history, psychiatric treatment and opioid agonist treatment when required. Gathered data was compared to the same time period in previous years.ResultsThe number of patients admitted to treatment drastically increased. Patients presented with poorer socioeconomic conditions, more psychiatric comorbidity and in need of more extensive treatment interventions.ConclusionsOur findings suggest that the pandemic and it’s socioeconomic impact affected drug users in need of HR interventions worsening underlying psychiatric disorders, poverty and inacessibility to healthcare. Drug users are often a forgotten population, and our results indicate that more attention should be devoted to them.DisclosureNo significant relationships.

Crack Cocaine Use Frequency is Associated With HIV Disease Severity Independent of Antiretroviral Therapy Exposure: A Prospective Cohort Study

Background: Prior evidence suggests that plasma HIV viral load is elevated during periods of crack cocaine use independent of antiretroviral therapy (ART) exposure. We sought to evaluate the effect of crack cocaine use frequency on HIV disease severity among HIV-positive people who use unregulated drugs (PWUD). Methods: We analyzed data from the ACCESS study, an open prospective cohort of HIV-positive PWUD including comprehensive HIV clinical monitoring in a setting with no-cost healthcare, including ART. Multivariable generalized linear mixed-effects models were used to estimate the independent effect of time-updated crack cocaine use frequency on HIV disease severity, adjusting for ART exposure and relevant confounders. HIV disease severity was measured using the Veterans Aging Cohort Study (VACS) Index, which is a validated prognostic index. Findings: Between 2005 and 2018, 806 individuals were recruited and contributed 8,537 observations. At baseline, the frequencies of crack cocaine use in the previous 180 days were: none (187, 23%), less than weekly (150, 19%), weekly (229, 28%), and daily or greater (240, 30%). In multivariable models adjusted for ART exposure and other confounders, daily or greater frequency of crack cocaine use was significantly associated with higher VACS Index scores (β = 0.9, 95% confidence interval: 0.2, 1.6) as compared to none. Interpretation: Daily or greater frequency of crack cocaine use may exacerbate HIV disease severity among HIV-positive PWUD. Although the observed effect was small, it was also independent of ART exposure. As this finding has been supported by previous evidence, the observed difference may reflect an underlying biological mechanism or other factors linked with crack cocaine use although further investigation is warranted. Funding Information: US National Institutes of Health. Declaration of Interests: We declare no competing interests. Ethics Approval Statement: The ACCESS study was approved by the University of British Columbia/Providence Healthcare Research Ethics Board.