Crystal Methamphetamine Use Research Articles

Preintervention Profiles of Information, Motivational, and Behavioral Self-Efficacy for Methamphetamine Use and HIV Medication Adherence Among Gay and Bisexual Men.

Although rates of crystal methamphetamine use in the United States have fallen from their peak in the mid-2000s, use remains a major public health concern, which disproportionately affects gay and bisexual men (GBM). It poses a particular challenge for HIV-positive men, for whom it has been linked to medication adherence problems as well as compromised immune function. Although the information, motivation, and behavioral skills (IMB) model has been widely used to conceptualize health behavior, little is known about GBM's initial levels of information, motivation, and behavioral self-efficacy to improve HIV medication adherence and to reduce crystal methamphetamine use at the outset of treatment. The present study identified profiles of IMB factors related to HIV medication adherence and crystal methamphetamine use in a sample of 210 HIV-positive GBM who consented to participate in an intervention study. Results indicated three distinct patterns of IMB factors. The largest group was ready to change both adherence and methamphetamine use (n = 104). This group also had depression scores that were significantly lower than other groups. A second group appeared ready to change medication adherence, but was ambivalent about changing methamphetamine use (n = 60). This group reported significantly more symptoms of methamphetamine dependence than the other groups. A third group was characterized by global IMB barriers to change (n = 46). Results are discussed in the context of tailoring psychoeducation, motivational interviewing, and cognitive behavioral interventions to match these preintervention patterns of IMB factors.

Following Lives Undergoing Change (Flux) study: Implementation and baseline prevalence of drug use in an online cohort study of gay and bisexual men in Australia

BackgroundDrug use among gay and bisexual men (GBM) is higher than most populations. The use of crystal methamphetamine, erectile dysfunction medication (EDM), and amyl nitrite have been associated with sexual risk behaviour and HIV infection among gay and bisexual men (GBM). ObjectiveThis paper describes an online prospective observational study of licit and illicit drug use among GBM and explores baseline prevalence of drug use in this sample. Capturing these data poses challenges as participants are required to disclose potentially illegal behaviours in a geographically dispersed country. To address this issue, an entirely online and study specific methodology was chosen. MethodsMen living in Australia, aged 16.5 years of age or older, who identified as homosexual or bisexual or had sex with at least one man in the preceding 12 months were eligible to enrol. ResultsBetween September 2014 and July 2015, a total of 2250 participants completed the baseline questionnaire, of whom, 1710 (76.0%) consented to six-monthly follow-up. The majority (65.7%) were recruited through Facebook targeted advertising. At baseline, over half (50.5%) the men reported the use of any illicit drug in the previous six months, and 28.0% had used party drugs. In the six months prior to enrolment, 12.0% had used crystal methamphetamine, 21.8% had used EDM, and 32.1% had used amyl nitrite. Among the 1710 men enrolled into the cohort, 790 men had used none of these drugs. ConclusionEase of entry and minimal research burden on participants helped ensure successful recruitment into this online cohort study. Study outcomes will include the initiation and cessation of drug use, associated risk behaviours, and health consequences, over time. Results will provide insights into the role gay community plays in patterns of drug use among GBM.

Increased prevalence of self-reported psychotic illness predicted by crystal methamphetamine use: Evidence from a high-risk population

BackgroundThe potential of methamphetamine, and high-potency crystal methamphetamine in particular, to precipitate psychotic symptoms and psychotic illness is the subject of much speculation internationally. Established psychotic illness is disabling for individuals and costly to society. The aim of this study was to investigate whether use of crystal methamphetamine was associated with greater prevalence of self-reported psychotic illness, compared to use of other forms of methamphetamine. MethodsThe sample comprised participants interviewed as part of an annual cross-sectional survey of Australian people who inject drugs. Comparisons were made between groups according to the nature of their methamphetamine use: crystal methamphetamine or other forms of methamphetamine. Self-reported diagnoses of psychotic illness and other mental health problems were compared between groups. Predictors of self-reported psychotic illness were examined using multivariable logistic regression analyses. ResultsSelf-reported psychotic illness was highly prevalent among users of crystal methamphetamine (12.0%), and significantly more so than among users of other forms of methamphetamine (3.9%) (OR=3.36; CI: 1.03–10.97). Significant predictors of self-reported psychosis in the cohort were: use of crystal methamphetamine; dependent use; lack of education beyond high school; and younger age. ConclusionHighly increased prevalence of self-reported psychotic illness is associated with use of high-potency crystal methamphetamine in people who inject drugs, particularly where there is dependent use. There is an urgent need to develop effective interventions for dependent crystal methamphetamine use; and a need to monitor for symptoms of psychotic illness in drug-using populations.

Critical considerations in responding to crystal methamphetamine use in Australian Aboriginal communities.

This article identifies factors that participants in a study based in an Australian regional centre believed to be critical to understanding and responding to crystal methamphetamine (ice) use among Aboriginal people. The study entailed a participatory methodology involving a university and an Aboriginal community controlled organisation. Semi-structured interviews conducted with ice users (n = 14), family members (n = 6) and workers (n = 6) were analysed thematically. Interviewees believed that historical trauma, contemporary disadvantage and racism cohere to produce a market for ice and other drugs within Aboriginal communities. Intense shame prevented some ice users and their families from seeking help, while fear about ice use was exacerbated when suppliers of ice threatened violence. Disconnection from family and community further intensified a sense of isolation and despair. By contrast, family reintegration provided ice users in the study with the strongest motivation for change. Although drawing only on a small sample of participants, the study suggests that Aboriginal people's experiences of ice use may have some distinct characteristics, meaning that tailored responses are required. Interventions should address the shame and ameliorate the fear that surround problematic ice use for families and users, provide help to those who feel trapped because of drug debts and relationships with dealers, and support families to maintain contact with ice users where this is manageable. Supports for users to remain connected to family and community are also critical. The effectiveness of family wellbeing interventions as adjuncts to treatment could be evaluated. [MacLean S, Hengsen R, Stephens R Critical considerations in responding to crystal methamphetamine use in Australian Aboriginal communities Drug Alcohol Rev 2017;36:502-508].

An Unusual Case of Hepatic Abscess After Rectal Use of Crystal Methamphetamine

Pyogenic Liver abscess occurs most commonly as a complication of biliary tract infection. We describe the first case of hepatic abscess developing in a patient with colitis secondary to rectal methamphetamine use. A 35 year old gentleman presented with RLQ abdominal pain, loose stools with mucus and painful defecation for 4 days. He is a homosexual male with a history of HIV on HAART, recurrent pancreatitis and multiple episodes of infectious colitis. A week before the symptoms, he had receptive sex, and used methamphetamine rectally. On admission, he was afebrile with stable vital signs and RLQ tenderness. Labs revealed mild leukocytosis, and elevated LFTs. CT scan was suggestive of an infectious or inflammatory proctocolitis, and a new 1.9 cm hypodensity in the right hepatic lobe. MRI of the abdomen showed 3.0 cm multi-loculated cystic collection representing intrahepatic abscess, with no significant biliary dilation. Rectal swab was positive for chlamydia, stool was negative for other pathogens including cyclospora and cryptococcus, viral hepatitis panel was negative. He was placed on meropenem for 6 weeks, and the abscess resolved. Pyogenic liver abscesses are the most common kind of visceral abscesses, usually arises in the setting of biliary disease, and less commonly as a consequence of portal vein pyema secondary to diverticulitis, appendicitis, perforated or penetrating peptic ulcer, GI malignancy, IBD, or peritonitis, in many cases it can be cryptogenic. The right lobe of the liver is usually affected, having better blood supply than the left or caudate lobes. We describe a rare case of pyogenic liver abscess in the setting of proctocolitis, in an MSM patient using rectal methamphetamine. There was no recent travel history that would suggest amoebic abscess, and no biliary disease was evident on imaging. There are only a few cases in the literature of transrectal use of methamphetamine, with associated methamphetamine toxicities. However, this is the first case that describes inflammatory colitis associated with methamphetamine use, and the only case to describe liver abscess in this setting. Transrectal methamphetamine abuse and rectal body stuffers are becoming more common, especially in the MSM community, and should be recognized as a possible cause of colitis, and pyogenic liver abscess.Figure 1Figure 2

Methamphetamine-Induced Colonic Ischemia

Introduction: Methamphetamines are sympathomimetic compounds that can trigger arterial vasospasm, leading to increased risk of ischemic events in watershed areas in colon. Case presentation: We present a case of a 51-year-old man who was brought to the emergency department for acute delirium. On physical examinations, he had tenderness without peritoneal signs in both lower quadrants and frank hematochezia on rectal examination. Laboratory findings revealed white blood cell count 17,000/μL, hematocrit 44.3%, sodium 165 mMol/L, BUN 70mg/dL, and creatinine 4.1mg/dL. CT abdomen showed diffuse wall thickening of descending and sigmoid colon, consistent with colitis (Figure 1). Urine toxicology was positive for cannabinoids and amphetamines. His mental status improved with appropriate correction of hypernatremia. He continued to have left lower quadrant abdominal pain and bloody diarrhea. Further history revealed extensive crystal methamphetamine use prior to admission. Colonoscopy revealed hyperemia, superficial erosions and sloughing of the necrotic mucosa in the proximal rectum, sigmoid and descending colon with evidence of shallow ulcerations (Figure 2). Biopsy showed superficial mucosal necrosis with sparing of the deeper colonic crypts (Figure 3). Diagnosis of methamphetamine-induced colonic ischemia was made and patient's symptoms subsequently improved with conservative management.Figure 1Figure 2Figure 3Discussion: Colonic ischemia is commonly reported in elderly or patients with comorbid cardiovascular disease. In our patient, there was no evidence of thromboembolic event or appreciable arteriosclerotic disease of the mesenteric vasculature. An important but commonly overlooked etiology is drug induced colonic ischemia. Common drugs include antibiotics, decongestants, and infrequently illicit drugs. To our knowledge, there are only a few reported cases of methamphetamine-induced colonic ischemia. The diagnosis is made on the basis of clinical, endoscopic and pathologic findings, with imaging aiding the assessment of distribution of colitis. The vasoconstrictor properties of amphetamine lead to alterations in splanchnic blood flow. Susceptible areas are splenic flexure (Griffith point) and sigmoid colon (Sudeck point). Cessation of amphetamine use and supportive care help in resolution of symptoms. In summary, this case highlights the importance of social history and to consider methamphetamine as a causation etiology patients suspected to have colonic ischemia.

Unsafe sexual behaviour associated with hazardous alcohol use among street-involved youth

ABSTRACTWhile risky sexual behaviours related to illicit drug use among street youth have been explored, the impacts of alcohol use have received less attention. This longitudinal study examined hazardous alcohol use among a population of street-involved youth, with particular attention to sexual and drug-related risk behaviours. Data were derived from the At-Risk Youth Study, a prospective cohort of street-involved youth in Vancouver, Canada. The outcome of interest was hazardous alcohol use defined by the US National Institute on Alcohol Abuse and Alcoholism. We used generalized estimating equations (GEEs) analyses to identify factors associated with hazardous alcohol use. Between 2005 and 2014, 1149 drug-using youth were recruited and 629 (55%) reported hazardous alcohol use in the previous 6 months during study follow-up. In multivariable GEE analyses, unprotected sex (adjusted odds ratio [AOR] = 1.28, 95% confidence interval [95% CI] = 1.12–1.46) and homelessness (AOR = 1.35, 95% CI = 1.19–1.54) were independently associated with hazardous alcohol use (all p < .001). Older age (AOR = 0.95, 95% CI = 0.92–0.99), Caucasian ethnicity (AOR = 0.74, 95% CI = 0.61–0.90), daily heroin use (AOR = 0.53, 95% CI = 0.42–0.67), daily crack cocaine smoking (AOR = 0.73, 95% CI = 0.59–0.91), and daily crystal methamphetamine use (AOR = 0.52, 95% CI = 0.42–0.64) were negatively associated with hazardous alcohol use (all p < .05). In sub-analysis, consistent dose–response patterns were observed between levels of alcohol use and unprotected sex, homelessness, and daily heroin injection. In sum, hazardous alcohol use was positively associated with unsafe sexual behaviour and negatively associated with high-intensity drug use. Interventions to address hazardous alcohol use should be central to HIV prevention efforts for street-involved youth.

Career readiness and externalizing behaviors of children affected by maternal HIV/AIDS: 15-year outcomes of the PACT study

ABSTRACTThe purpose of this 15-year longitudinal study was to assess the effects of maternal HIV/AIDS on child/adolescent career readiness and externalizing behaviors. Interviews were conducted with 66 pairs of healthy children and their mothers living with HIV/AIDS (MLH), who are participants in the Parents And children Coping Together (PACT) project begun in 1997. All study participants were English or Spanish speaking. About half (48.5%) of the youth were female. Maternal health status (e.g., viral load biomedical marker, illness symptoms, physical functioning, and depression) and child/adolescent outcomes (e.g., career readiness, conduct disorder, drug use, sexual behaviors, parent attachment, and youth autonomy) were assessed over 20 time-points. Individual growth and GEE logistic regression models showed lower variability in maternal viral load was positively associated with better career readiness and parent attachment among adolescent/young adults. Externalizing behaviors (conduct disorder, alcohol, and crystal methamphetamine use) were positively associated with maternal depression. Adolescent coping efficacy was shown to be a protective factor when applied to models on career readiness. Stability in MLH health positively affects children’s career readiness over time, particularly career planning and career choices. The finding that adolescent coping efficacy may act as a protective factor against poor career planning has important implications for developing interventions to assist children in coping with parental HIV.

Initiation of drug dealing among a prospective cohort of street-involved youth

ABSTRACTBackground: Street-involved youth who use drugs may have limited income-generation options and are known to commonly become immersed in illicit drug markets to generate funds. However, little attention has been given to factors that may drive drug dealing initiation among this vulnerable population. Objectives: This longitudinal study examines drug dealing initiation among street-involved youth. Methods: Data were derived from the At-Risk Youth Study from September 2005 to November 2014; a prospective cohort of 194 street-involved youth who use drugs aged 14–26, in Vancouver, Canada. Extended Cox model was used to identify factors independently associated with time to first drug dealing. Results: Among street-involved youth who had never dealt drugs at baseline, 56 (29%) individuals initiated drug dealing during the study period for an incidence density of 13.0 per 100 person-years (95% confidence interval [CI]: 9.9–17.2). In multivariable Cox regression analysis, male gender (adjusted hazard ratio [AHR] = 1.90, 95% CI: 1.06–3.42), homelessness (AHR = 1.88, 95% CI: 1.05–3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47–4.20), and crack cocaine use (AHR = 2.35, 95% CI: 1.38–4.00) were positively and independently associated with initiating drug dealing. Conclusion: Homelessness and stimulant drug use were key risk factors for drug dealing initiation among street-involved youth. Findings indicate that evidence-based and innovative interventions, including youth-centric supportive housing, low threshold employment programs, and stimulant addiction treatment should be implemented and evaluated as strategies to help prevent this vulnerable population from engaging in risky illegal income generation practices.

Predictors of crystal methamphetamine use in a community-based sample of UK men who have sex with men

BACKGROUND: Crystal methamphetamine ('crystal meth') use by men who have sex with men is an ongoing public health issue in the UK. We conducted a descriptive epidemiological study to characterise demographic and socio-sexual risk factors for crystal meth use in a national sample of UK MSM recruited in late 2014. METHODS: We used data from the 2014 Gay Men's Sex Survey (n=16,565), an online community-based survey in the UK. We used logistic regression to relate risk factors to last-year use of crystal meth. RESULTS: In univariate models, crystal meth use was significantly associated with being between the ages of 30 and 49 (30-39, OR 2.24; 40-49, OR 2.21), living in London, having received a positive HIV test result (OR 7.37, 95% CI [6.28, 8.65]), and with higher education qualifications (1.40, [1.13, 1.75]), as well as with having multiple steady (2.15, [1.73, 2.68]) and non-steady (13.83, [10.30, 18.58]) partners with condomless anal intercourse. Relationships were similar in multivariate models, but education was no longer associated with last-year crystal meth use and lack of full-time employment was. CONCLUSIONS: This analysis confirms and updates previous findings from the UK. Crystal meth use may now be more concentrated in London since previous surveys. This analysis presents novel findings regarding the association between number and sexual risk with partners and last-year meth use.Copyright © 2016. Published by Elsevier B.V. Language: en

Crystalline methamphetamine use and methamphetamine-related harms in Australia.

Concerns about crystal methamphetamine use and harm have increased in multiple countries. This paper describes how changes in the availability and use of crystal methamphetamine have impacted on methamphetamine-related harms in Australia. Data on methamphetamine use were obtained from population-level surveys, health service data and surveys of drug use among sentinel groups of ecstasy users and people who inject drugs. Data were obtained on seizures, arrests, clandestine laboratory detections, hospital separations, mental health unit admissions, drug telephone helpline calls and drug treatment episodes. Segmented linear regression models were fitted to identify changes in these series using log-transformed data where appropriate. The availability of crystal methamphetamine has increased as evidenced by increased laboratory detections, domestic seizures and purity of the seized drug. Population surveys do not report an increase in the number of people who used at least once in the past year. However, more users report using crystal methamphetamine rather than lower-purity powder methamphetamine and more regular use. Indicators of methamphetamine-related harms have increased in parallel with this change. Amphetamine-related helpline calls, drug treatment, arrests and hospital admissions for amphetamine disorders and psychosis all peaked in the mid-2000s, declined for several years and have increased steeply since 2010. The increased availability and use of crystal methamphetamine have been associated with increased regular use and harms. Treatment is required for those experiencing problems and the capacity of health services to provide care needs to be enhanced.[Degenhardt L, Sara G, Connor JP, McKetin R, Roxburgh A, Dobbins T, Farrell M, Burns L, Hall WD. Crystalline methamphetamine use and methamphetamine-related harms in Australia. Drug Alcohol Rev 2017;36:160-170].

Trends in methamphetamine residues in wastewater in metropolitan and regional cities in south-east Queensland, 2009-2015.

Over the past several years, the Australian media have reported increased use and harm arising from the use of crystal methamphetamine (“ice”),1,2 a highly pure form of the drug that can be smoked or injected.2 We used wastewater analysis to examine trends in methamphetamine residues in wastewater samples from the inlets of two treatment plants in south-east Queensland. One plant served a coastal metropolitan city that included entertainment precincts and the other a major inland regional city...

High-Intensity Drug Use and Health Service Access Among Street-Involved Youth in a Canadian Setting

Background/Objectives: Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high-intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access.Methods: Data were derived from the At-Risk Youth Study, a Vancouver-based prospective cohort of street-involved youth aged 14–26. We used generalized estimating equations to examine variables associated with high-intensity drug use, defined as daily use of crack cocaine, cocaine, heroin, or crystal methamphetamine. Results: From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high-intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age (Adjusted Odds Ratio [AOR] = 1.47); residing in the Downtown Eastside of Vancouver (AOR = 1.46); homelessness (AOR = 1.30); recent incarceration (AOR = 1.25); inability to access addiction treatment (AOR = 1.42); and crack pipe sharing and/or used syringe injecting (AOR = 2.64), were all positively and independently associated with high-intensity drug use (p < 0.05). The most common barrier to accessing addiction treatment reported by these youth was long waiting lists. Conclusions: High-intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.

Why the FUSS (Fentanyl Urine Screen Study)? A cross-sectional survey to characterize an emerging threat to people who use drugs in British Columbia, Canada

BackgroundFentanyl-detected illicit drug overdose deaths in British Columbia (BC) recently increased dramatically from 13 deaths in 2012 to 90 deaths in 2014, signaling an emerging public health concern. Illicit fentanyl is sold as pills or powders, often mixed with other substances like heroin or oxycodone; reports from coroners suggested that fentanyl was frequently taken unknowingly by people who use drugs. This study aimed to assess the prevalence and characteristics of fentanyl use among clients accessing harm reduction (HR) services in BC.MethodsParticipants attending HR services at 17 sites across BC were invited to complete an anonymous questionnaire describing drugs they have used within the last 3 days and provide a urine sample to test for fentanyl. Data from eligible participants were analyzed using descriptive, bivariate, and multivariate statistical methods.ResultsSurveys from 17 HR sites were received, resulting in analysis of responses from 242 eligible participants. Most participants used multiple substances (median = 3), with crystal meth (59 %) and heroin (52 %) use most frequently reported. Seventy participants (29 %) tested positive for fentanyl, 73 % of whom did not report using fentanyl. Controlling for age, gender, and health authority, reported use of fentanyl (odds ratio (OR) = 6.13, 95 % confidence interval (CI) = [2.52, 15.78], p < 0.001) and crystal methamphetamine (OR = 3.82, 95 % CI = [1.79, 8.63], p < 0.001) use were significantly associated with fentanyl detection.ConclusionsThe proportion of those testing positive who did not report knowingly using fentanyl represents a considerable public health concern. The risk of overdose among this vulnerable population highlights the need for targeted HR strategies, such as increased accessibility to naloxone, overdose education, and urine screens.

Nested Event-Level Case-Control Study of Drug Use and Sexual Outcomes in Multipartner Encounters Reported by Men Who Have Sex with Men.

Previous event-level analyses have often, but not always, found significant associations between drug use and sexual risk behaviour in men who have sex with men (MSM), but these analyses have rarely considered either multipartner encounters specifically, or other sexual outcomes such as pleasure and control. Using data from an internet-based longitudinal survey of MSM, we tested the association between drug use by respondent and by partners and unprotected anal intercourse (UAI), pleasure and control over sexual activity. Overall respondent substance use was significantly associated with increased odds of UAI, though not with pleasure or control. Respondent use of crystal methamphetamine was significantly associated with both increased odds of UAI and decreased odds of control over sexual activity. This analysis agrees with previous studies of dyadic encounters, and specifically suggests that the association between crystal methamphetamine and sexual risk behaviour may be mediated by loss of control.

Can differences in the type, nature or amount of polysubstance use explain the increased risk of non-fatal overdose among psychologically distressed people who inject drugs?

BackgroundThis study investigates whether the type, nature or amount of polysubstance use can explain the increased risk of non-fatal overdose among people who inject drugs with severe psychological distress. MethodsData came from three years (2011–2013) of the Illicit Drug Reporting System (IDRS), an annual sentinel sample of injecting drug users across Australia (n=2673). Structural Equation Modelling (SEM) was used on 14 drug types to construct five latent factors, each representing a type of polysubstance use. Tests of measurement invariance were carried out to determine if polysubstance use profiles differed between those with and without severe psychological distress. Next, we regressed non-fatal overdose on the polysubstance use factors with differences in the relationships tested between groups. FindingsAmong those with severe psychological distress a polysubstance use profile characterised by heroin, oxycodone, crystal methamphetamine and cocaine use was associated with greater risk of non-fatal overdose. Among those without severe psychological distress, two polysubstance use profiles, largely characterised by opioid substitution therapies and prescription drugs, were protective against non-fatal overdose. ConclusionThe types of polysubstance use profiles did not differ between people who inject drugs with and without severe psychological distress. However, the nature of use of one particular polysubstance profile placed the former group at a strongly increased risk of non-fatal overdose, while the nature of polysubstance use involving opioid substitution therapies was protective only among the latter group. The findings identify polysubstance use profiles of importance to drug-related harms among individuals with psychological problems.

Drug use patterns predict risk of non-fatal overdose among street-involved youth in a Canadian setting

BackgroundNon-fatal drug overdose is a major cause of morbidity among people who use drugs, although few studies have examined this risk among street-involved youth. We sought to determine the risk factors associated with non-fatal overdose among Canadian street-involved youth who reported illicit drug use. MethodsUsing data from a prospective cohort of street-involved youth in Vancouver, Canada, we identified youth without a history of overdose and employed Cox regression analyses to determine factors associated with time to non-fatal overdose between September 2005 and May 2012. ResultsAmong 615 participants, 98 (15.9%) reported a non-fatal overdose event during follow-up, resulting in an incidence density of 7.67 cases per 100 person-years. In multivariate Cox regression analyses, binge drug use (adjusted hazard ratio [AHR]=1.85; 95% confidence interval [CI]=1.20–2.84), non-injection crystal methamphetamine use (AHR=1.70; 95% CI=1.12–2.58), non-injection prescription opiate use (AHR=2.56; 95% CI=1.36–4.82), injection prescription opiate use (AHR=2.49; 95% CI=1.40–4.45) and injection heroin use (AHR=1.85; 95% CI=1.14–3.00) were positively associated with time to non-fatal overdose. Social, behavioural and demographic factors were not significantly associated with time to non-fatal overdose event. ConclusionsRates of non-fatal overdose were high among street-involved youth. Drug use patterns, in particular prescription opiate use, were associated with overdose. These findings underscore the importance of addiction treatment and prevention efforts aimed at reducing the risk of overdose among youth.

Primary health-care responses to methamphetamine use in Australian Indigenous communities.

Crystal methamphetamine (commonly known as 'ice') use is currently a deeply concerning problem for some Australian Indigenous peoples and can cause serious harms to individual, families and communities. This paper is intended to support best practice responses by primary health-care staff working with Australian Indigenous people who use methamphetamine. It draws on a systematic search of relevant databases to identify literature from January 1999 to February 2014, providing an overview of prevalence, treatment, education and harm reduction, and community responses. The prevalence of methamphetamine use is higher in Indigenous than non-Indigenous communities, particularly in urban and regional settings. No evidence was identified that specifically related to effective treatment and treatment outcomes for Indigenous Australians experiencing methamphetamine dependence or problematic use. While studies involving methamphetamine users in the mainstream population suggest that psychological and residential treatments show short-term promise, longer-term outcomes are less clear. Community-driven interventions involving Indigenous populations in Australia and internationally appear to have a high level of community acceptability; however, outcomes in terms of methamphetamine use are rarely evaluated. Improved national data on prevalence of methamphetamine use among Indigenous people and levels of treatment access would support service planning. We argue for the importance of a strength-based approach to addressing methamphetamine use, to counteract the stigma and despair that frequently accompanies it.

Crystal methamphetamine use and HIV medical outcomes among HIV-infected men who have sex with men accessing support services in New York

BackgroundDrug use poses multiple challenges to maintaining physical health among HIV-infected individuals, particularly with regard to disease progression. Few studies, however, have examined the association between the use of crystal methamphetamine (“crystal meth”) and HIV disease progression specifically among HIV-infected men who have sex with men (MSM). Understanding this relationship among HIV-infected MSM is particularly critical because of the high rates of crystal meth use reported in the population. MethodsAssociations between recent crystal meth use and poor HIV medical outcomes (viral load>200 copies/mL, CD4 count <350 cells/mm3) were analyzed for 2896 HIV-infected MSM enrolled in Ryan White Part A programs in the greater New York metropolitan area between November 2010 and June 2012. ResultsCrystal meth use (reported by 4%) was independently associated with unsuppressed viral load (AOR=1.8, CI=1.1–2.9) in multivariate analyses controlling for sociodemographic characteristics. There was no significant relationship between crystal meth use and low CD4 counts. ConclusionsTo date, little research has examined how crystal meth use influences HIV medical outcomes among HIV-infected MSM. This analysis showed a significant independent association between crystal meth use and unsuppressed viral load among MSM in an HIV service population. Future studies should examine biological and psychosocial mediators, moderators and confounders of this relationship to inform intervention development for MSM crystal meth users in HIV care settings.

Development of a brief substance use sensation seeking scale: validation and prediction of injection-related behaviors.

Sensation seeking, a personality trait, has been shown to predict engagement in high-risk behaviors. However, little is known regarding the impact of sensation seeking on substance use among street youth. We therefore sought to modify a sensation seeking scale (SSS) for use among this population. Street youth from the Vancouver-based At-Risk Youth Study (n=226) completed the modified SSS. Exploratory and confirmatory factor analysis (EFA/CFA) were undertaken to establish the scale's dimensionality and internal validity. The association between SSS score and injection-related behaviors was tested using generalized estimating equation analysis. EFA results indicated scale unidimensionality. The comparative fit index (CFI) suggested acceptable fit (CFI=0.914). In multivariate analysis, sensation seeking was independently associated with injection drug use, crystal methamphetamine use, polysubstance use, and binge drug use (all p<0.05). Our findings provide preliminary support for the use of the modified SSS among street youth.