Implementation of a collaborative model for opioid overdose prevention on campus.

Drug overdose is the leading cause of death for Americans under the age of 50, a crisis that is driven by an increasingly potent supply of illicit opioids. College-aged adults are more likely than any other age group to engage in opioid misuse. Naloxone, the antidote for an opioid overdose, can save the life of an opioid overdose victim if it is readily available and administered quickly. The University of Texas at Austin implemented a collaborative model for proactive opioid overdose prevention in 2016. This model includes stocking naloxone in residence halls and providing it to police officers, training resident advisors and police officers to respond to suspected overdoses, and engaging student pharmacists in a service learning program to increase naloxone access and awareness among university students. Programmatic experiences and key recommendations for U.S. campuses are shared by faculty, student, and community leaders.

Demographic, HIV risk behavior, and health status characteristics of "crack" cocaine injectors compared to other injection drug users in three New England cities.

OBJECTIVES: To compare demographic, HIV risk behaviors, and health status characteristics of injection drug users (IDUs) who have injected "crack" cocaine with IDUs who have not. METHODS: Nine hundred and eighty-nine IDUs were recruited in New Haven, CT, Hartford, CT and Springfield, MA from January 2000 to May 2002. Participants were administered a modified version of the National Institute on Drug Abuse Risk Behavior Assessment Questionnaire. RESULTS: Nine percent (n = 89) of participants reported "ever" injecting crack cocaine and 4.2% (n = 42) reported injecting crack in the past 30 days. Lifetime and current crack injectors did not differ significantly on any demographic characteristics. Lifetime and current crack injectors did not differ on gender, age or marital status from IDUs who have never injected crack. Significant differences were found on race, education, employment and residence, with crack injectors more likely to be white, employed, better educated and living in New Haven than IDUs who have never injected crack. After adjusting for current (past 30 day) speedball and powder cocaine injection, crack injectors reported higher rates of risky drug use behaviors and female crack injectors reported higher rates of risky sexual behaviors. Crack injectors reported higher rates of abscesses, mental illness and Hepatitis C infection, but not Hepatitis B or HIV infection. CONCLUSIONS: The emergence of crack cocaine injection requires urgent attention, as this new drug use behavior is associated with elevated rates of high risk behaviors.

Chronic pain, addiction severity, and misuse of opioids in Cumberland County, Maine.

BACKGROUND: Few studies have examined the relationship between chronic pain and opioid abuse in non-clinical populations. We sought to investigate this in a street-recruited sample of active opioid abusers in Cumberland County, Maine, USA, a locale that had experienced substantial increases in opioid abuse. METHODS: A community-based sample was recruited using respondent-driven sampling. Participants were screened to identify those who had consumed illicit opioids in the prior month and administered a structured survey that included the Addiction Severity Index (ASI) and Brief Pain Inventory® (BPI). RESULTS: More than 40% of the 237 individuals reported recurring pain that interfered with daily living. For more than three-quarters of those reporting chronic pain, opioid misuse preceded the onset of chronic pain. The order of onset was not associated with differences in sociodemographic, current levels of drug misuse, or ASI and BPI scores. BPI scores were associated with medical and psychological ASI domains. Compared to those not reporting chronic pain, those doing so were more likely to have a regular physician but were more likely to report difficulty gaining admission to substance abuse treatment programs. CONCLUSION: Chronic pain was a common co-occurring condition among individuals misusing opioids. Better efforts are needed to integrate pain management and substance abuse treatment for this population.

Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997-2007.

BACKGROUND: The leading cause of injury death among adults in Connecticut (CT), USA is drug poisonings. We analyzed the epidemiology and geographic distribution of opioid-involved accidental drug-involved intoxication deaths ("overdoses") in CT over an 11-year period. METHODS: We reviewed data from 1997 to 2007 on all adult accidental/undetermined drug intoxication deaths in CT that were referred to the Office of the Chief Medical Examiner (OCME). Regression analyses were conducted to uncover risk factors for fatal opioid-involved intoxications and to compare heroin- to prescription opioid- and methadone-involved deaths. Death locations were mapped to visualize differences in the geographic patterns of overdose by opioid type. RESULTS: Of the 2900 qualifying deaths, 2231 (77%) involved opioids. Trends over time revealed increases in total opioid-related deaths although heroin-related deaths remained constant. Methadone, oxycodone and fentanyl, the most frequently cited prescription opioids, exhibited significant increases in opioid deaths. Prescription opioid-only deaths were more likely to involve other medications (e.g., benzodiazepines) and to have occurred among residents of a suburban or small town location, compared to heroin-involved or methadone-involved deaths. Heroin-only deaths tended to occur among non-Whites, were more likely to involve alcohol or cocaine and to occur in public locations and large cities. CONCLUSIONS: The epidemiology of fatal opioid overdose in CT exhibits distinct longitudinal, risk factor, and geographic differences by opioid type. Each of these trends has implications for public health and prevention efforts.

Perceptions of sexual risks and injection for HIV among African American women who use crack cocaine in Nashville, Tennessee.

Significant health disparities in the rates of HIV infection primarily affect African American women. Although research has demonstrated that for some individuals HIV is connected to preventable high-risk behaviors related to substance use, a further examination of how these risks are perceived by the individuals involved in these activities is warranted. This study presents the results of 11 focus groups with 89 African American women who use crack cocaine in which respondents shared their perceptions of HIV risk behaviors. The results of this study suggest that women crack cocaine users in Nashville,Tennessee, are not injecting the drug. There appeared to be high levels of perceived sexual risks associated with the use of crack cocaine by some users; however, this was not universal, as many active users have internalized HIV prevention messages. The results of this study are significant in that further understanding of the means by which individuals experience their risk behaviors will enable more effective targeting of potential interventions to reduce the spread of HIV.

The effect of acids on the survival of HIV during drug injection.

BACKGROUND: HIV epidemics around the world have been linked to injection drug use. In many instances, the injected drugs are acidic. HIV-1 is known to be labile to acids, but its susceptibility to acids in the conditions in which illicit drugs are injected is unknown. METHODS: We have combined data from ethnographic studies of injection drug use practices with laboratory virology to replicate and evaluate the effects of exposure to acids that are experienced during drug preparation and injection on HIV-1 viability. RESULTS: Short exposures to the acids significantly reduced the likelihood of recovering viable HIV-1 once pH is reduced to 2.3, but acidic solutions did not totally eliminate infectious HIV-1 that might contaminate syringes or solutions being injected, even at the lowest pH tested (pH 1.7). CONCLUSIONS: Acidification of drugs, which is required for dissolving free-base formulations of drugs, can significantly reduce but not eliminate the likelihood that syringes previously used by HIV-1-infected injection drug users infect the next injector. Methamphetamines, which are manufactured under extremely acidic pHs, are unlikely to harbor viable HIV if stored or sold in contaminated injection equipment.

Illicit use of opioids: is OxyContin a "gateway drug"?

This study examines whether individuals who engage in illicit, non-medical use of OxyContin are distinguishable from other non-medical users of opioids and whether OxyContin serves as a "gateway" to heroin and/or injection drug use. The study sample included active nonmedical users of opioids, who are 16 years or older and residents of Cumberland County, Maine. Possible associations between type of opioid used and behavioral and descriptive variables were assessed. The study sample was predominantly urban-dwelling, male, Caucasian, and economically disadvantaged. OxyContin users could only be distinguished from heroin users (cf non-heroin opioid users). Polyopioid use within the first year of initiation was associated with quicker progression to heroin and injection drug use.