Measuring Attitudes Toward Injecting Drug Users and People with Hepatitis C

Preexisting scales used to measure attitudes toward human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and homosexuals were adapted to assess attitudes toward people with hepatitis C (HCV) and injecting drug users (IDUs). In 2005, 110 undergraduate psychology students completed these scales, and abbreviated versions of the IDU and HCV scales were then administered to 61 health care workers to establish their relevance in the field. Results indicated that the new scales have good reliability and validity with undergraduates and with health care workers in an applied setting.     

AIDS Beliefs and Behaviors among Intravenous Drug Users in Bangkok

Prompted by an explosive epidemic of HIV-1 in early 1988 among Thai IVDUs under treatment for heroin use, a series of focus group discussions were conducted at six Bangkok detoxification clinics. In developing qualitative information on knowledge of and attitudes toward AIDS, and on drug use and sexual behavior, our objectives were to identify intervention measures, develop culturally-appropriate educational material, strengthen counseling, and sharpen the focus of needed quantitative research. An abundant store of diverse anecdotal responses and reactions emerged. We discuss the reliability and the policy and research implications of these findings.     

浅谈发挥电视在药品监督管理中的舆论作用

本文结合本省实际工作经验,论述了充分发挥电视在药品监督管理工作中的舆论作用,同时提出,舆论监督应是建设性监督,要着眼于分析问题、解决问题,以达到促进工作的目的。     

An Examination of Opinions Toward Marijuana Policies Among High School Seniors in the United States

Support for marijuana (cannabis) legalization is increasing in the US, and state-level marijuana policies are rapidly changing. Research is needed to examine correlates of opinions toward legalization among adolescents approaching adulthood as they are at high risk for use. Data were examined from a national representative sample of high school seniors in the Monitoring the Future study (years 2007-2011; N = 11,594) to delineate correlates of opinions toward legalization. A third of students felt marijuana should be entirely legal and 28.5% felt it should be treated as a minor violation; 48.0% felt that if legal to sell it should be sold to adults only, and 10.4% felt it should be sold to anyone. Females, conservatives, religious students, and those with friends who disapprove of marijuana use tended to be at lower odds for supporting legalization, and Black, liberal, and urban students were at higher odds for supporting more liberal policies. Recent and frequent marijuana use strongly increased odds for support for legalization; however, 16.7% of non-lifetime marijuana users also reported support for legalization. Findings should be interpreted with caution as state-level data were not available, but results suggest that support for marijuana legalization is common among specific subgroups of adolescents.     

Sociodemographic Disparities in Access to Addiction Treatment Among a Cohort of Vancouver Injection Drug Users

Vancouver's explosive HIV epidemic among injection drug users (IDUs) has received international attention due to the presence of a large needle exchange program. The role of addiction treatment has not been evaluated in this setting. We evaluated factors associated with use of addiction treatment among a prospective cohort of Vancouver IDUs. Addiction treatment was negatively associated with Aboriginal ethnicity and unstable housing, both of which have been associated with HIV infection in previous studies. These findings demonstrate low levels of addiction treatment among Vancouver IDUs and suggest that programs may need to be targeted towards specific populations with poor access.     

The Influence of Medical Student Gender and Drug Use on the Detection of Addiction in Patients

Little is known about medical students’ interest in their training on drug addiction, their personal experience of consumption, and whether these aspects influence the detection of addiction in patients. Eighty-eight and one half percent considered that drug dependence issues are important to their professional future. The students report consuming alcohol (69%), cigarettes (19.5%), and illegal drugs (15.8%). Female students consumed fewer illegal drugs than the men (p =.022). Male students consumed more illegal drugs more frequently (p =.005), knew more consumers (p =.023), and those who drink alcohol consumed more illegal drugs than women who drink alcohol (p <.005). Drug and alcohol consumption among medical students may serve to normalize consumption and thus, may prevent the detection of addicts. It is important to educate and raise awareness about drugs and alcohol use, as this may influence detection. The focus should be particularly on the male group.     

Stigma and subjectivities: Examining the textured relationship between lived experience and opinions about drug policy among people who inject drugs

Abstract

Aims: The way people who inject drugs (PWID) feel about drug policy may be profoundly shaped by lived experience of stigma and the subjectivities made available in policy and practice. Using a community-based participatory research approach, this study investigated why PWID hold particular views, and considered the complexities of how lived experience and opinions about drug policy intersect within this affected community. Methods: Three qualitative focus groups were undertaken. Participants were presented with survey results arising from a previous study, and asked to interpret and explain the possible rationales underlying the opinions expressed by their peers. Findings: A duality of opinion was identified, borne from lived experience of stigmatisation, which sometimes led PWID to qualify levels of support. By exploring the rationales underlying opinions, a tension emerged between what PWID theoretically know to be effective interventions, and experiences of how policies are delivered. A sense of “within-group” stigma emerged, with sub-groups of users and drug types denoted as more “dangerous” than others. Conclusions: This study illustrates how theoretical knowledge and lived experience intersect to inform opinions about drug policy. Through in-depth discussions with the affected community, we are reminded that public opinion research is always an interpretative and sensitive pursuit.     

Predictors and Outcome of Aftercare Participation of Alcohol and Drug Users Completing Residential Treatment

This study attempts to identify factors associated with greater aftercare participation for 367 adults who completed abstinence-based residential addiction treatment between and at Bellwood Health Services in Toronto, Canada. Pre-treatment substance use, number of days spent in residential treatment, motivation, treatment satisfaction, and demographics were used to determine which characteristics predicted greater aftercare participation. The duration of residential treatment and treatment satisfaction emerged as significant predictors of aftercare attendance. Regular aftercare attendance was associated with lower levels of substance use at 6-month follow-up. Results suggest that a longer duration of residential treatment can influence continuing care engagement and highlight the importance of initial treatment retention for long-term recovery.     

Medical Illness and Comorbidities in Drug Users: Implications for Addiction Pharmacotherapy Treatment

Providing effective medical care to those with substance use disorders can be a challenge to clinicians. In this article, we briefly summarize issues that occur frequently in the medical treatment of substance users. The focus of this article is twofold. The first is to briefly summarize common co-occurring medical illnesses in those manifesting substance use disorders with an emphasis on issues related to providing effective treatment for these diseases in this population. Using specific examples of frequently occurring comorbid medical illness in substance users, including infectious diseases (hepatitis C and HIV disease), sexually transmitted diseases, and pregnancy as examples, the complexities of medical care for this population is demonstrated. Second, this article addresses some of the difficulties encountered in pharmacotherapy aimed specifically at treatment of substance use disorders. For example, difficulties in managing concomitant opiate therapy in those requiring medications for medical illness that may have strong and adverse interactions with opiates are addressed. Adverse events reported for some substance use disorder pharmacotherapies are also highlighted. We conclude with a brief review of models of care that have been effective in addressing the needs of this challenging population that can provide additional means for enhancing the clinical care of substance users.     

Saying no to weed: Public opinion towards cannabis legalisation in Uruguay

Aims: This research aimed to explore people’s beliefs associated with opposition to cannabis legalisation in Uruguay. In 2014, Uruguay passed a national law regulating the production, sale and consumption of recreational marijuana. However, two-thirds of the Uruguayan public expressed disagreement towards the government’s new policy.

Methods: This study used logistic regressions on data from a national probabilistic sample of 1512 adults in Uruguay. Opinions and beliefs towards cannabis legalisation were collected in face-to-face interviews, using a battery of questions included in Vanderbilt University’s AmericasBarometer national survey in 2014.

Findings: Results showed that opposition to legalisation in Uruguay is independently associated with the beliefs that the new cannabis law will worsen the public security conditions in the country, that it will serve as a gateway to the use of harder drugs, and that the law will ultimately be ineffective to curb illegal trafficking. They also showed the importance of political ideology.

Conclusions: Public views towards cannabis liberalisation are more intertwined with concerns about public security and apprehension that it will open the gate to heavier drugs than with concerns about individual health and demographic factors. The paper underscores the importance of belief systems and political socialisation over personal behaviour of use.     

Development and Psychometric Evaluation of Scales that Assess Stigma Associated With Illicit Drug Users

This study established validity evidence for scales that assess perceived public stigma and stigmatization of illicit drug use. These concepts were measured with respect to five commonly used drugs: marijuana, powder cocaine, ecstasy, and nonmedical use of opioids and amphetamine. Data were collected from a diverse sample of 1,048 emerging adults in New York City in 2009. Exploratory and confirmatory factor analyses suggested two distinct factors, which were inversely related to exposure to users and recent use of each drug. These measures demonstrated good criterion, construct, and incremental validity and effectiveness in analyzing predictors of use. Study limitations were discussed.     

Adverse drug reaction reporting: Opinions and attitudes of medical practitioners in Ireland

Despite the critical role of adverse drug reaction (ADR) reporting in ensuring the safety of drugs in clinical practice, fewer than 10% of such reactions are reported. We analysed the views of 207 doctors in Ireland and, although well disposed towards reporting, most doctors (97%) were uncertain about the reporting criteria of the regulatory agency, the National Drugs Advisory Board (NDAB), and unclear as to the purposes of the reporting scheme. The unavailability of report forms (52%) or the address of the NDAB (28%), together with being too busy or unsure how to report were identified as major deterrents to reporting. There was general agreement about the factors important in the decision to report—seriousness of the reaction, an unusual reaction or a reaction to a new product. Almost 90% of doctors requested guidelines on reporting and regular bulletins on ADRs. Our survey indicates that doctors need ongoing education and information about this important area of drug safety if the benefits of their positive attitudes towards it are to be realized.     

An Exploratory Qualitative Study of Polydrug Use Histories Among Recently Initiated Injection Drug Users in San Juan,Puerto Rico

It is well documented that drug users often modulate the effects of their primary drugs of use (e.g., cocaine) by using other drugs (e.g., alcohol), yet the effect of modulating and primary drug interactions on transitions from one class of drugs to another and from noninjected drugs to injected drugs is not clear. This issue, which is critical for understanding polydrug abuse, is explored in formative research based on in-depth qualitative interviews conducted during 2003–2004 with 25 recently initiated drug injectors residing in San Juan, Puerto Rico. This study suggests that increased use of a primary drug (e.g., cocaine) was influenced by enhancing or attenuating drugs, which were used in a particular order (e.g., alcohol, heroin) reflecting effectiveness in modulating primary drugs at different use intensities, as well as by participants’ perceptions of the relative dangers associated with different drugs. Neither availability nor access appeared to affect the order in which participants used modulating drugs.     

The Role of Physician and Nurse Attitudes in the Health Care of Injecting Drug Users

In 2005, 60 health care workers were recruited through services that attract injecting drug users (IDUs) and asked to complete attitude measures regarding IDU clients. Mediation analyses indicated that conservative health care workers displayed more negative attitudes toward their IDU clients because they believe that injecting drug use is within the control of the IDU. Negative attitudes toward IDU clients, in turn, were associated with worry about IDU clients’ behavior in the clinic and with beliefs that IDU clients should disclose their hepatitis C status to their health care worker. Perceptions of controllability of drug use were also associated with the belief that IDU clients’ ailments were caused by their IDU status. The study's limitations are noted.     

A Cross-Sectional Assessment of Utilization of Addiction Treatment among Injection Drug Users in Kabul,Afghanistan

The purpose of this study was to describe prior use of detoxification and addiction-treatment programs among injection drug users (IDUs) in Kabul, Afghanistan. From 2005–2006, IDUs (n = 464) recruited into this cross-sectional study completed an interviewer-administered questionnaire and whole blood rapid testing with fingerstick samples for HIV, syphilis, and hepatitis C antibody and B surface antigen testing. Participants were predominantly male (99.8%), Afghan (98.9%), and had little formal education. Correlates of detoxification and addiction treatment were identified with logistic regression. The majority (94.0%, n = 435) felt great/urgent need for treatment, of whom 56.3% (n = 245) reported inability to access treatment. Prior detoxification was associated with new needle use with each injection (AOR = 1.91, 95% CI: 1.12–3.26) and prior incarceration (AOR = 1.81, 95% CI: 1.04–3.13). The study's limitations are noted. Rapid scale-up and subsidy of needle and syringe programs and opioid agonist treatment is urgently needed in Kabul.     

Tolerance and Sensitization to the Effects of Cocaine Use in Humans: A Retrospective Study of Long-Term Cocaine Users in Philadelphia

In the effort to develop medications to combat addiction, researchers have developed models that attempt to describe the neurobiological process of cocaine dependence. It has not, however, yet been determined which of these models, if any, best fits the behaviors and experiences of patients. This project retrospectively evaluated changes in patients' experiences with cocaine over time in order to clarify the model that best fits clinical observations. In 2005 and 2007, 100 treatment-seeking, long-term cocaine users were recruited from an urban university-based treatment center in Philadelphia, PA, United States. Each participant was administered the “Cocaine History Questionnaire” which asked them to describe the initiation and escalation of their cocaine usage, changing reward perceptions, and effects of intoxication at certain points in their drug use careers. This data was then analyzed using repeated measures, examining the within subject differences in reported information over the time points. We found evidence that while the amount of drug used increases, self-reported euphoria decreases while negative symptoms associated with cocaine use also increase. The data provide preliminary evidence for the hedonic dysregulation model of addiction. Limitations and implications of the study are discussed in the conclusion.     

Knowledge and stigma regarding methadone maintenance treatment among personnel of methadone maintenance treatment and non-methadone maintenance treatment addiction facilities in Israel

Stigma attached to methadone maintenance treatment is very common. The objective of the current article is to evaluate the presence of stigma and its relation to the extent of knowledge about methadone maintenance treatment. The authors conducted a survey among methadone maintenance treatment and non-methadone maintenance treatment addiction therapists from different treatment centers in Israel, including methadone maintenance treatment clinics (Ministry of Health) and non-methadone maintenance treatment addiction facilities (Ministry of Social Services), using an anonymous questionnaire about methadone maintenance treatment stigma and knowledge. There were 63 therapists from methadone maintenance treatment clinics (63%) and 46 therapists from the social services department (SSD) non-methadone maintenance treatment addiction facilities (9.2%) who responded. Methadone maintenance treatment versus social services department personnel were older (42.7 ± 12.8 versus 37.5 ± 8.2 years; p = 0.03), with fewer females (48 versus 75%; p = 0.006), and 50% were social workers compared to 100% social workers in the SSD group (p < 0.0005). Stigma score was lower among methadone maintenance treatment personnel compared to the social services department personnel (3 ± 2.5 versus 5.0 ± 3.5; p = 0.0001), while the knowledge score about methadone maintenance treatment was higher among the methadone maintenance treatment personnel (10.3 ± 2.9 versus 7.7 ± 2.8; p < 0.0005). The difference in both the stigma and knowledge scores remained significant after controlling for age, gender, and profession. There was a negative correlation between the stigma and knowledge scores among both the methadone maintenance treatment (R = –0.5, p < 0.0005) and the social services department personnel (R = –0.33, p = 0.03). These results revealed a significant correlation between the presence of stigma and the extent of education and knowledge about methadone maintenance treatment, with ignorance and stigma against methadone maintenance treatment being more pronounced among social services department personnel. An educational intervention, especially among social services department personnel, may benefit people who use opioids and improve the overall quality of treatment for opioid addiction in Israel.     

对门诊处方用药适宜性审核工作的思考

目的:探讨门诊处方审核工作的方法及对开展药学服务的意义。方法:对我院2005年1月~2005年6月门诊处方的审核结果进行汇总、分析,并对突出问题作重点讨论。结果:在所审核的处方中,各类非合理用药的比例除抗感染药物占47.39%外,存在相互作用和重复用药的比例分别为25·78%、12·89%。结论:门诊处方审核可为药剂人员搭建起掌握医师用药状态的平台;医师需要更多药物相互作用方面的信息,为药学服务注入了新的工作内容。     

First Consumers,Then Socially Integrated: Results of a Study on 100 Italian Drug Users Who Had Never Turned to Public or Private Addiction Services

This study, which addressed a per quota sample of 100 socially integrated drug users (SID) residing in Emilia Romagna (Italy) who have never referred to a public/private Addiction Service, has four main aims: (1) to describe the phenomenology of substance use in all its different facets; (2) to identify feared unwanted consequences due to the use of illegal substances and possible behaviors finalized to preventing them; (3) to identify possible common consumption rules; (4) to identify any differences among the SID. Two types of consumers have been compared: the “law-breakers” (i.e. those who have committed an illegal activity to procure money) and the “law-abiders” (no such action).From the interviewees some discontinuous consumption trajectories over time are reported in relation to the different levels of disposable income and the change in the relationship with the substances. Most of these consumers fear being stigmatized or labeled as drug-addicts, and cause themselves physical, psychological or economic harm; instead only a minority fear developing addiction. The most widespread protective behavior is to purchase through trusted direct channels, followed by the attempt to limit the doses and to consume only in positive emotional states. Rules of conduct implemented at a general level by all the consumers were evidenced, which the law-breakers finalize towards a greater attention to their own psycho-physical health and to better handling the effects produced by the substances, while the law-abiders seek to keep their status as consumers secret.