Hepatitis C Virus Infection in Persons Who Inject Drugs in the Middle East and North Africa: Intervention Strategies.

There is a high incidence and prevalence of hepatitis C viral infection in persons with or without substance use disorders (SUDs) in the Middle East and North Africa (MENA) region, but only a small number receive comprehensive care. Highly effective direct-acting antiviral (DAA) medications are available at substantially lower costs; however, complete elimination of the hepatitis C virus (HCV) can only be achieved if integrated care strategies target those at highest risk for HCV infection and transmission and improve access to care. Due to the high prevalence of SUD in the MENA region, strategies to eliminate HCV must focus on integrated healthcare across multiple subspecialties, including addiction medicine, psychiatry, infectious diseases, hepatology, and social work. In this invited manuscript, we review the epidemiology of HCV in the MENA region and highlight intervention strategies to attain the WHO's goal of HCV eradication by 2030.

The COVID-19 cannabis health study: Results from an epidemiologic assessment of adults who use cannabis for medicinal reasons in the United States.

Background: Clinical indications for medicinal cannabis include chronic conditions; thus users (MCUs) are at an increased risk of morbidity and mortality resulting from SARS-CoV-2 infection (COVID-19). The study aimed to provide data on cannabis use and self-reported behavioral changes among MCUs with preexisting chronic conditions in response to the pandemic.Methods: An internet-based questionnaire was administered to adults ≥18 who self-reported medicinal cannabis use within the past year. Data are from respondents between March 21 and April 23, 2020; response rate was 83.3%. Health conditions and cannabis frequency, route, and patterns of use were assessed via the COVID-19 Cannabis Health Questionnaire (Vidot et al. 2020).Results: Participants (N = 1202) were predominantly non-Hispanic white (82.5%) and 52.0% male (mean age 47.2 years). Mental health (76.7%), pain (43.7%), cardiometabolic (32.9%), respiratory (16.8%), and autoimmune (12.2%) conditions were most reported. Those with mental health conditions reported increased medicinal cannabis use by 91% since COVID-19 was declared a pandemic compared to those with no mental health conditions (adjusted odds ratio: 1.91, 95% CI: 1.38-2.65). 6.8% reported suspected COVID-19 symptoms. Two percent (2.1%) have been tested for COVID-19 with only 1 positive test result. Some MCUs (16%) changed their route of cannabis administration, switching to nonsmoking forms.Conclusions: The majority of MCUs reported at least one preexisting chronic health condition. Over half report fear of COVID-19 diagnosis and giving the virus to someone else; yet only some switched from smoking to nonsmoking forms of cannabis. Clinicians may consider asking about cannabis use among their patients, particularly those with chronic health conditions.

Itinerário terapêutico e assistência à saúde de usuários de drogas na rede de atenção psicossocial / Therapeutic itinerary and health care for drug users in the psychosocial care network / Itinerario terapéutico y atención sanitaria para usuarios de drogas en la red de atención psicosocial

Objetivo: compreender a percepção de usuários de drogas acerca do itinerário terapêutico e da assistência à saúde na Rede de Atenção Psicossocial. Método: Pesquisa de abordagem qualitativa desenvolvida com usuários de drogas assistidos em um Centro de Atenção Psicossocial Álcool e outras drogas nos meses de março a maio de 2019. A coleta dos dados foi a partir da entrevista semiestruturada e analisados por meio da análise temática. Resultados: evidenciou-se que os usuários de drogas fazem uma ampla peregrinação na rede de saúde em busca de acolhimento e que a assistência à saúde está pautada em um modelo manicomial, centrado na medicalização em alguns serviços. Conclusão: a assistência prestada nos serviços de âmbito territorial não acolhe o usuário e nem garante a integralidade do cuidado, o que faz com que esses peregrinem pela Rede

Objective: to understand the perception of drug users about the therapeutic itinerary and health care in the Psychosocial Care Network. Method: Qualitative research conducted with drug users assisted at a Psychosocial Care Center for Alcohol and other drugs from March to May 2019. Data collection was based on the semi-structured interview and analyzed using thematic analysis. Results: it was evidenced that drug users make a wide pilgrimage in the health network in search of welcoming and that health care is based on a mental hospital model, centered on medicalization in some services. Conclusion: the assistance provided in the services of territorial scope does not welcome the user and does not guarantee the integrality of care, which makes these pilgrims through the Network

Objetivo: comprender la percepción de los usuarios de drogas sobre el itinerario terapéutico y asistencial en la Red de Atención Psicosocial. Método: investigación cualitativa realizada con usuarios de drogas atendidos en un Centro de Atención Psicosocial por Alcohol y otras drogas de marzo a mayo de 2019. La recolección de datos se basó en la entrevista semiestructurada y se analizó mediante análisis temático. Resultados:se evidenció que los usuarios de drogas realizan un amplio peregrinaje en la red de salud en busca de acogida y que la atención sanitaria se basa en un modelo de hospital psiquiátrico, centrado en la medicalización de algunos servicios. Conclusión: la asistencia prestada en los servicios territoriales no acoge al usuario y no garantiza la integralidad de la atención, que realizan estos peregrinos a través de la Red

Barriers and motivators to participation and retention in HIV/HCV cohort studies among people who inject drugs: a community consultation in Iran.

BACKGROUND: The lack of robust estimates of HIV/HCV incidence among people who inject drugs (PWID) in Iran calls for well-designed prospective cohort studies. Successful recruitment and follow-up of PWID in cohort studies may require formative assessment of barriers PWID are faced with in participation and retention in cohort studies and factors they think may facilitate their engagement in such studies. Using a focus group discussion (FGD) format, we conducted a consultation with PWID in southeast Iran to recognize those barriers and motivators. METHODS: Using targeted sampling and through snowball referrals, we recruited PWID (aged≥18, injected in last 6 months) from community-based drop-in centers (DICs), homeless shelters, and through outreach efforts to participate in four FGDs (one women-only). Socio-demographic characteristics, injection behaviors and self-reported HCV/HIV testing and diagnosis history were obtained. Then, a semi-structured FGD guide was applied to explore barriers and motivators to participation and retention in cohort studies among study participants. All FGD sessions were recorded and transcribed verbatim, removing any identifying information. The content of FGDs were analyzed by thematic analysis using an inductive approach. RESULTS: In total, 30 individuals (10 women) participated in the study. The median age of participants was 35 (IQR 31-40), with majority (73.3%) reporting injecting drug use within the last month. Only 40.0% reported ever being tested for HCV whereas a larger proportion (63.4%) reported ever being tested for HIV. While the majority were willing to participate in cohort studies, breach of confidentiality, fear of positive test results, perceived required commitment, and marginalization were reported as barriers to participation and retention in such studies. Monetary incentive, the thought of a better life, protection from police interventions and trust between health workers and PWID were addressed as motivators of engagement in cohort studies among PWID. CONCLUSIONS: Strategies to enhance data security and reduce stigma associated with injecting drug use along with involving peer workers in research, providing pre and post-test counselling and education and addressing the needs of more marginalized groups potentially through integrated healthcare programs and housing support are among few approaches that may help address barriers and strengthen the motivators for successful cohort studies among this population.

Drug use and antiretroviral therapy (ART) interactions: a qualitative study to explore the knowledge, beliefs, adherence, and quality of life of people living with HIV taking ART and illicit drugs.

BACKGROUND: To explore the use of illicit drugs by people living with HIV (PLHIV) taking antiretroviral therapy (ART) and their relationship with variables relevant to the management of HIV infection, such as knowledge and beliefs about drug-drug interactions (DDIs), ART adherence, quality of life (QoL), and use of health-care resources. METHODS: 21 PLHIV in Spain who concomitantly took illicit drugs and ART participated in this qualitative study. Eight experts collaborated in the design of the semi-structured interview guide which explored the following topics: illicit drug use, knowledge and beliefs about DDIs and their impact on ART adherence, the effects of using illicit drugs on health, QoL, and use of health-care resources. Four of those experts, who were PLHIV and members of the executive boards of non-government organizations (NGOs) from four Spanish regions, recruited the participants through their NGOs and carried out the face-to-face interviews. Content analysis of the qualitative data was conducted with the support of the MAXQDA 12 program. RESULTS: Participants were mainly men (85.7%) and only 14.3% of them were heterosexual. Content analysis showed that the most frequently consumed illicit drugs were poppers, cocaine, and cannabis. Participants were polydrug users and this was, in many cases, prior to HIV diagnosis. Most participants presented theoretical potential moderate DDIs that would require monitoring. More than three quarters of them were not aware of these DDIs. Participants reported interactive toxicity beliefs that lead to intentional nonadherence behaviors. In most cases (n = 17), the participant's doctor knew about their drug use, however only six of them had had an open dialogue with their physician about it. Illicit drug use led to some health-related problems, mainly sexually transmitted infections. A positive QoL's self-perception was found among several participants that used recreational illicit drugs. CONCLUSIONS: Adequate information about DDIs and clues about how to manage ART when PLHIV are using illicit drugs could reduce the negative effects of such interactions and improve ART adherence and QoL.

Personality Traits in Former Spanish Substance Users Recovered with Ayahuasca.

Ayahuasca is a psychoactive brew that contains N,N-dimethyltryptamine and monoamine oxidase-inhibiting alkaloids. It is originally from the Amazon rainforest, but since the 1990s it has expanded worldwide. The compound is used in different religious, spiritual, and therapeutic settings. One of its common applications is for the treatment of addiction. The current study is an assessment of the impact of ayahuasca on personality traits in former substance users from Catalonia and surrounding areas. When compared with a control group, the ayahuasca group had statistically significantly higher scores in the dimensions Novelty Seeking and Self-Transcendence, and in the traits Attachment, Impulsivity, Compassion, and Spiritual Acceptance. Results suggest that recovery could be related less to a reduction of Impulsivity and Novelty Seeking, main features of substance use disorder (SUD), and more to an increase of Character dimensions and traits, especially Self-Transcendence and Cooperativeness. Those changes could be triggered by self-reflective, prosocial, and transcendental ayahuasca ritual experiences, which in the qualitative part of the research were described by the participants as being of great importance for their recovery, helping with the reconstruction of personal goals, gratifications, social bonds, and the general life's projection.

Exploring gender differences among treatment-seekers who use opioids versus alcohol and other drugs.

Identifying clinical differences between opioid users (OU) and alcohol and other drug users (AOD) may help to tailor treatment to OU, particularly among the majority of OU who are not on opioid agonist treatments. Given the dearth of research on these differences, this study explored gender differences in demographic and clinical characteristics between OU and AOD. Participants (N = 506) were from a multisite, randomized controlled clinical trial of an Internet-delivered psychosocial intervention conducted in 2010-2011. Logistic regression models explored differences in demographic and clinical characteristics by substance use category within and between women and men. Women OU were more likely to be younger, White, employed, benzodiazepine users, and less likely to have children or use cocaine and cannabis than women AOD. Men OU, compared to men AOD, were more likely to be younger, White, younger at first abuse/dependence, benzodiazepine users, and reported greater psychological distress, but were less likely to be involved in criminal justice or use stimulants. Interactions by gender and substance use were also detected for age of first abuse/dependence, employment, and criminal justice involvement. These findings provide a nuanced understanding of gender differences within substance use groups to inform providers for OU seeking treatment.

Barriers and facilitators in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs: A qualitative study of midwives' experience.

BACKGROUND: Screening pregnant women for substance use is highly recommended in antenatal care settings. Although midwives provide routine screening for substance use and referral for treatment in pregnancy, little is known about the barriers and facilitators they experience. AIM: The study explored barriers and facilitators experienced by midwives in antenatal settings to screening and referral of pregnant women who use alcohol or other drugs. DESIGN/SETTING: A semi-structured interview was adopted to explore barriers and facilitators experienced by midwives in screening and referring pregnant women for alcohol or other drugs specialised services. Eighteen midwives were recruited from urban, regional and rural antenatal settings in Victoria. Interviews were tape recorded and transcribed verbatim. Themes were generated by thematic analysis, the process of identifying patterns within the data. FINDINGS: Of the seven themes identified under barriers, five could be categorised as "institution and provider-related", namely: (i) lack of validated screening tool, (ii) inadequate support and training, (iii) discomfort in screening, (iv) lack of multidisciplinary team and specialised treatment in regional and rural areas, and (v) workload and limited consultation time. Conversely, two themes could be classified as 'client-related', namely (i) non- or partial-disclosure of substance use, and (ii) reluctance and non-adherence to referrals. All five themes under facilitators were "institution and provider-related." They are (i) a woman-centred philosophy of care, (ii) evidence of harms from substance use on neonates, (iii) experience and training, (iv) continuity of care, and (v) availability of multidisciplinary team and funding. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: To the best of our knowledge, this is the first study of its kind conducted in Victoria. This study not only adds to the limited body of knowledge on barriers experienced by midwives but also identifies facilitators in antenatal settings that promote screening and referral of pregnant women who use substance. Most of the barriers and facilitators are interrelated. Despite midwives' willingness to screen all pregnant women for substance use and provision of referral, they often felt limited in their capacity. Availability and accessibility to validated screening tool(s), in addition to regular, ongoing training for all midwives to maintain clinical competence and provide effective communication are imperative. Availability of a multidisciplinary team, funds and specialised care facilities such as detoxification and mental health services, especially in regional and rural areas, are necessary to effectively support at-risk pregnant women.

Sobreviver nas ruas: percursos de resistência à negação do direito à saúde / Sobrevivir en las calles: resistencias a la negación del derecho a la salud / Surviving on the streets: paths of resistance to the denial of health rights

RESUMO. Contextos de exclusão conformam ciclos de marginalização de grupos populacionais, como a população em situação de rua (PSR). Nesse contexto violações de direitos humanos são recorrentes, em especial a dificuldade de acesso à saúde. A efetivação das políticas para a PSR nas cidades brasileiras ainda é escassa, por sua restrição a cidades de médio e grande porte e ao parco investimento público. Dessa forma, o estudo tem por objetivo investigar os percursos de cuidado à saúde da PSR em um município de pequeno porte. Foram realizadas observações de campo e entrevistas semiestruturadas para identificação e compreensão dos recursos acionados nas trajetórias de cuidado à saúde, que foram analisadas a partir da análise de conteúdo temática. Ressaltaram-se as diversas estratégias desenvolvidas pelo público diante da negação do direito à saúde e ao autocuidado. Destacam-se entre os resultados a precariedade de ofertas ao cuidado da saúde da mulher, a restrição do cuidado em saúde ao uso de substâncias psicoativas, de cunho medicalizante e centrado no paradigma da abstinência. Observou-se a importância da moradia para o cuidado integral, e das redes sociais e comunitárias como forma de restabelecimento da saúde nas ruas.

RESUMEN. Los contextos de exclusión conforman ciclos de marginación de grupos poblacionales, como la población en situación de calle (PSC). En este contexto, violaciones de derechos humanos son recurrentes, en especial la dificultad de acceso a la salud. La efectividad de las políticas para la PSC en las ciudades brasileñas sigue siendo escasa, por su restricción a ciudades de mediano y gran porte y a la poca inversión pública. Así, el estudio buscó investigar los recorridos de cuidado a la salud de la PSC en una ciudad de pequeño porte. Se realizaron observaciones de campo y entrevistas semiestructuradas para identificación y comprensión de los recursos accionados en las trayectorias de cuidado de la salud, que fueron analizadas a partir del análisis de contenido temático. Se resaltan las diversas estrategias desarrolladas por este público como forma de resistencia a la negación del derecho a la salud y autocuidado. Se destacan la precariedad de ofertas al cuidado de la salud de la mujer, la restricción del cuidado en salud al uso de sustancias psicoactivas, de cuño de medicalización y centrado en el paradigma de la abstinencia. Se observaron la importancia de la vivienda para el cuidado integral, y de las redes sociales y comunitarias como forma de restablecimiento de la salud en las calles.

ABSTRACT. Exclusion contexts constitute cycles of marginalization of population groups, such as the homeless people (HP). In this context, human rights violations are recurrent, especially related to the difficulty of access to health services. The effectiveness of the policies for HP in Brazilian cities is still scarce, due to its restriction to medium and large cities and the limited public investment. Thus, the study sought to investigate HP health care paths in a small city. Field observations and semi-structured interviews were carried out to identify and understand the resources used in health care trajectories, which were analyzed based on thematic content analysis. Several strategies developed by the public in the face of the denial to the health rights and self-care are highlighted. Among the results, the precariousness of offers to women's health care, the restriction of health care to the use of psychoactive substances, of medicalizing nature and centered on the abstinence paradigm were stood out. It was observed the importance of housing for comprehensive care, and social and community networks as a way of restoring health on the streets.

Terapia Comunitária como cuidado complementar a usuários de drogas e suas contribuições sobre a ansiedade e a depressão / Terapia Comunitaria como atención complementaria para usuarios de drogas y sus contribuciones a la ansiedad y la depresión / Community Therapy as complementary care for drug users and their contributions to anxiety and depression

Resumo Objetivo avaliar as contribuições da Terapia Comunitária sobre a ansiedade e a depressão entre usuários de drogas psicoativas. Métodos estudo quase-experimental, realizado com 21 homens residentes em três instituições de saúde mental voltadas à recuperação da dependência química, submetidos a seis rodas de terapia comunitária como processo de intervenção em 2018. A coleta de dados ocorreu em três etapas a partir do uso de um questionário semiestruturado e dois inventários de ansiedade e depressão de Beck. Utilizou-se método estatístico não-paramétricos na comparação dos resultados. Resultados a depressão esteve presente entre 76% dos usuários e a ansiedade entre 48%. Dentre os participantes das rodas, houve uma redução nos níveis de depressão durante e após o processo de intervenção (p=0,016; p=0,004) quando comparado ao estado inicial e para manter a média dos escores de ansiedade no T1 e T2 (9,90; 9,95) se comparado ao T0 (13,10). Conclusão e implicações para a prática o uso da terapia comunitária demonstrou resultados positivos sobre a ansiedade e a depressão, sendo então considerada uma importante ferramenta de cuidado em saúde mental a ser utilizada por enfermeiros, com vistas a ampliar o seu cuidado as pessoas em situação de dependência química, contribuindo ainda para adesão ao tratamento.

Resumen Objetivo evaluar las contribuciones de la terapia comunitaria sobre la ansiedad y la depresión entre los consumidores de drogas psicoactivas. Método se realizó un estudio cuasiexperimental con 21 hombres residentes en tres instituciones de salud mental focalizadas en la recuperación de la dependencia química, sometidos a seis rondas de terapia comunitaria como proceso de intervención en 2018. La recolección de datos se realizó en tres etapas, a saber: uso de un cuestionario semiestructurado y dos inventarios de ansiedad y depresión de Beck. Se utilizó un método estadístico no paramétrico para comparar los resultados. Resultados la depresión estuvo presente en un 76% de los consumidores y la ansiedad en el 48%. Entre los participantes en las ruedas, hubo una reducción en los niveles de depresión durante y después del proceso de intervención (p = 0.016; p = 0.004) en comparación con el valor inicial y para mantener el puntaje promedio de ansiedad T1 y T2 (9.90; 9.95) en comparación con T0 (13.10). Conclusión e implicaciones para la práctica el uso de la terapia comunitaria ha mostrado resultados positivos sobre la ansiedad y la depresión y, por lo tanto, se considera como una importante herramienta de atención a la salud mental a ser utilizada por las enfermeras, con a fin de extender su atención a las personas que se encuentran en una situación de dependencia química, además de fomentar la adhesión al tratamiento.

Abstract Objective to evaluate the contributions of Community Therapy on anxiety and depression among psychoactive drug users. Methods a quasi-experimental study was conducted with 21 men living in three mental health institutions focused on recovery from chemical dependence, who underwent six rounds of community therapy as an intervention process in 2018. Data collection took place in three stages from the use of a semi-structured questionnaire and two Beck anxiety and depression inventories. The nonparametric statistical method was used to compare the results. Results depression was present in 76% of users and anxiety in 48%. Among the participants in the yarning circles, there was a reduction in depression levels during and after the intervention process (p=0.016; p=0.004) when compared to baseline and to maintain the average T1 and T2 anxiety score (9.90; 9.95) compared to T0 (13.10). Conclusion and implications for practice the use of community therapy has shown positive results on anxiety and depression, and therefore is considered in this study as an important mental health care tool to be used by nurses, aiming to expand their care to people in a situation of chemical dependence, also contributing to treatment adherence.

A Terapia Comunitária Integrativa como estratégia de intervenção psicossocial para usuários de substâncias psicoativas / A Terapia Comunitária Integrativa como estratégia de intervenção psicossocial para usuários de substâncias psicoativas

A Terapia Comunitária Integrativa ou Terapia Comunitária é um recurso terapêutico com a finalidade de estabelecer redes de apoio na vivência do indivíduo, por meio de rodas de conversa sistematizadas, capazes de promover relatos de inquietações e problemas advindos do cotidiano. Esta pesquisa teve como objetivo avaliar os efeitos da Terapia Comunitária Integrativa como estratégia de intervenção psicossocial, desatacando suas contribuições sobre os sintomas de depressão e ansiedade e sobre a autoestima e autoeficácia de pessoas usuárias de substâncias psicoativas. Trata-se de um estudo com duas abordagens. A primeira quantitativa quase-experimental e a segunda qualitativa documental retrospectiva. O estudo foi realizado com 21 homens residentes em três instituições de saúde mental voltadas à recuperação da dependência química, submetidos a seis rodas de terapia comunitária como processo de intervenção em 2018. A coleta de dados quantitativos ocorreu em três etapas (antes, durante e depois da intervenção), a partir da aplicação de questionário semiestruturado, da Escala de Autoestima de Rosenberg, da Escala de Autoeficácia Geral Percebida, do Inventário de Ansiedade de Beck e do Inventário de Depressão de Beck, analisados pelo método estatístico não paramétricos na comparação dos resultados. Os dados qualitativos foram coletados a partir dos registros das fichas de apreciação e fechamento das rodas de TCI, que foram avaliadas por análise do conteúdo. A pesquisa foi aprovada pela EERP-USP sob parecer nº 2.487.000. O uso da terapia comunitária foi eficaz para reduzir os níveis de depressão durante e após o processo de intervenção e para manter a média dos escores de ansiedade ao longo do processo, se comparado ao início da intervenção. Evidências apontaram que a TCI também foi eficaz para melhorar os níveis de autoestima e autoeficácia nos três tempos avaliados, sendo mais evidente quando comparado antes e depois da intervenção. No que diz respeito à avaliação das fichas de registro das rodas, verificou-se que as principais demandas dos usuários estiveram relacionadas ao contexto familiar, ao sofrimento e ao desconforto aparente. As estratégias mais utilizadas no enfrentamento da dependência química foram: manejo de sentimentos negativos, fortalecimento dos vínculos sociais, apoio na religiosidade e tratamento recebido. Os principais benefícios para os usuários estiveram relacionados ao acolhimento, à comunhão, ao espaço de bem-estar, à expectativa de futuro, ao aprendizado, ao respeito, ao pertencimento e à esperança. Os resultados da melhoria da autoestima, autoeficácia, ansiedade e depressão dos usuários de substâncias psicoativas e os benefícios da participação nas rodas mostram que o uso da Terapia Comunitária Integrativa podem melhorar a qualidade de vida desses usuários, devendo ser então utilizada como uma estratégia de intervenção em saúde mental com vistas a ampliar as opções terapêuticas de cuidado a essa população.

Integrative Community Therapy (TCI) or Community Therapy (TC) is a therapeutic resource that aims to establish support networks in the individual's experience, through systematized conversation wheels, able to promote reports of concerns and problems arising from everyday life. This research aimed to evaluate the effects of Integrative Community Therapy as a psychosocial intervention strategy, deattacking its contributions on the symptoms of depression and anxiety and on the self-esteem and self-efficacy of people using psychoactive substances. This study has two approaches. The first quasi-experimental quantitative and the second retrospective documentary qualitative. The study was conducted with 21 men living in three mental health institutions focused on recovery from addiction, who attended six community-therapy wheels as an intervention process in 2018. Quantitative data collection occurred in three stages (before, during and after the intervention), from the application of a semi-structured questionnaire, the Rosenberg Self-Esteem Scale, the Perceived General Self-Efficacy Scale, the Beck Anxiety Inventory and the Beck Depression Inventory, analyzed by the nonparametric statistical method in the comparison of the results. Qualitative data were collected from the records of the TCI wheels closure and appreciation forms, which were evaluated by content analysis. The research was approved by the EERP-USP under opinion No. 2,487,000. The use of community therapy was effective in reducing depression levels during and after the intervention process and in maintaining the average anxiety scores throughout the intervention compared to the beginning of the intervention. Evidence showed that TCI was also effective to improve self-esteem and self-efficacy levels in the three evaluated times, being more evident when compared before and after the intervention. Regarding the evaluation of wheel record forms, the main demands of users were related to the family context, suffering and discomfort. The most used strategies in coping with chemical dependence were management of negative feelings, strengthening of social bonds, support in religiosity and the treatment received. The main benefits for users were related to reception, communion, well-being, future expectation, learning, respect, belonging and hope. The results of improved self-esteem, self-efficacy, anxiety and depression of psychoactive substance users and the benefits of wheel participation show that the use of Integrative Community Therapy can improve their quality of life and should be used as an intervention tool in. mental health with a view to expanding the therapeutic care options to this population.

Determining the Roles that Club Drugs, Marijuana, and Heavy Drinking Play in PrEP Medication Adherence Among Gay and Bisexual Men: Implications for Treatment and Research.

Researchers have established that substance use interferes with anti-retroviral medication adherence among gay and bisexual men (GBM) living with HIV. There is limited parallel examination of pre-exposure prophylaxis (PrEP) adherence among HIV-negative GBM. We conducted retrospective 30-day timeline follow-back interviews and prospective semi-weekly diary data for 10 weeks with 104 PrEP-using GBM, half of whom engaged in club drug use (ketamine, ecstasy, GHB, cocaine, or methamphetamine)-generating 9532 days of data. Participants reported their day-by-day PrEP, club drug, marijuana, and heavy alcohol use (5 + drinks in one sitting). On average, club drug users were no more likely to miss a dose of PrEP than non-club drug users (M = 1.6 doses, SD = 3.0, past 30 days). However, we found that club drug use (at the event level) increased the odds of missing a dose on the same day by 55% and the next day (e.g., a "carryover effect") by 60%. Further, missing a dose on one day increased the odds of missing a dose the following day by eightfold. We did not identify an event-level effect of marijuana use or heavy drinking on PrEP adherence. Our data suggest club drug users could have greater protective effects from daily oral or long-acting injectable PrEP compared to a time-driven PrEP regimen because of the concurrence of club drug use and PrEP non-adherence.

Attitudes of nursing students towards substance users and perceptions about religious/spiritual care.

OBJECTIVE: To evaluate the impact of an educational intervention on the attitudes of Nursing students towards users of psychoactive substances (excluding alcohol and tobacco) and their perceptions about the religious and spiritual care offered within the health services. METHOD: Quasi-experimental study. We applied a questionnaire before and one month after an intervention about the comprehensive care of substance users, containing: sociodemographic information, knowledge, the Treatment Spirituality/Religiosity Scale, and the Drug and Drug Problems Perceptions Questionnaire. For the analyses, we employed the paired Student's t-test and Pearson's Coefficient. RESULTS: 62 students participated in this study. After the intervention, there was improvement in the students' attitudes towards the substance users, but not regarding the perception they already had about the importance of offering religious and spiritual care within the services. CONCLUSION: We verified the effectiveness of the educational intervention on the improvement of attitudes concerning the care of substance users, yet we point out that the students did not show changes in their perception about the inclusion of the religious and spiritual aspects in the care dedicated to this population.

Experiences and perceptions of people who use heroin: public health lessons from Hermosillo, Mexico.

Heroin consumption in Mexico is low compared with its use in the United States; however, this practice is more common in the northern region of Mexico than in the rest of the country, being documented only in cities that are located exactly at the Mexico-U.S. border. The Mexican legal framework is focused on rehabilitation, but its effects on the lives of users are unknown. The objective of this research was to analyze how the regulatory Mexican framework is conceptualized and practiced in the daily life of a group of heroin users from a northern city, where consumption has recently spread and has not been documented. We collected the official registered data from users and conducted a qualitative study in Hermosillo, Sonora. A research on the legal framework was conducted, as well as on the city's context. Data on heroin users can be found at HIV health center, as there is no other source of such records. The Mexican legal framework aims at rehabilitation and at avoiding criminalization; however, the daily life of users drives them towards crime circuits: people commit crimes to stay in prison, where they can control the addiction and get heroin, in case of abstinence. The Mexican State has no empirical information to improve its programs and laws related to the use of heroin. The daily practices of users become not only epidemiological but social risks to the community and to the users themselves. Also, the lack of access due to stigmatization, criminalization and violence, increases the inequities, creating a cycle that reproduces poverty and suffering as part of a social structure. Therefore, changes are needed in the justice system.

Dietary Intake Among Opioid- and Alcohol-Using Pregnant Women.

BACKGROUND: Substance abuse in nonpregnant adults has been associated with increased intake in calories and decreased intake of nutrient-dense foods; however, studies examining dietary intake in opioid-using and alcohol-using pregnant women are lacking. OBJECTIVE: The objective of this study was to evaluate dietary intake in opioid-using pregnant women with or without concurrent light-to-moderate alcohol use as compared to abstaining controls. METHODS: This prospective birth cohort included 102 pregnant women classified into four study groups: controls (n = 27), medication-assisted treatment (MAT; n = 26), alcohol (ALC; n = 22), and concurrent use of both substances (MAT + ALC; n = 27). Percentage differences in macro- and micronutrient intake were estimated from the food frequency questionnaire and compared among the study groups. Proportions of participants with intakes below the estimated average requirements (EAR) based on diet and diet with supplements were estimated. RESULTS: Three exposed groups had lower prevalence of multivitamin use in periconceptional period (11.5-31.8%) than controls (44.4%). Unadjusted mean energy intake was significantly higher in the MAT + ALC group compared to controls, while micronutrient intake per 1000 kcal was the highest in the control group for almost all of the micronutrients analyzed. After adjustment for energy intake and sociodemographic characteristics, MAT group had lower estimated dietary intake of iron (-15.0%, p = 0.04) and folate (-16.8%, p = 0.04) compared to controls. A high proportion of participants in all study groups had dietary intake below the EAR for vitamin E, iron, and folate. CONCLUSION: Results highlight the need for targeted dietary interventions for opioid-using pregnant women.

Experiences and perceptions of people who use heroin: public health lessons from Hermosillo, Mexico / Experiencias y percepciones de personas que usan heroína: lecciones de salud pública desde Hermosillo, México / As experiências e percepções de usuários de heroína: lições de saúde pública de Hermosillo, México

Abstract: Heroin consumption in Mexico is low compared with its use in the United States; however, this practice is more common in the northern region of Mexico than in the rest of the country, being documented only in cities that are located exactly at the Mexico-U.S. border. The Mexican legal framework is focused on rehabilitation, but its effects on the lives of users are unknown. The objective of this research was to analyze how the regulatory Mexican framework is conceptualized and practiced in the daily life of a group of heroin users from a northern city, where consumption has recently spread and has not been documented. We collected the official registered data from users and conducted a qualitative study in Hermosillo, Sonora. A research on the legal framework was conducted, as well as on the city's context. Data on heroin users can be found at HIV health center, as there is no other source of such records. The Mexican legal framework aims at rehabilitation and at avoiding criminalization; however, the daily life of users drives them towards crime circuits: people commit crimes to stay in prison, where they can control the addiction and get heroin, in case of abstinence. The Mexican State has no empirical information to improve its programs and laws related to the use of heroin. The daily practices of users become not only epidemiological but social risks to the community and to the users themselves. Also, the lack of access due to stigmatization, criminalization and violence, increases the inequities, creating a cycle that reproduces poverty and suffering as part of a social structure. Therefore, changes are needed in the justice system.

Resumen: El consumo de heroína en México es bajo si se compara con su consumo en EE.UU.; no obstante, esta práctica es más común en la zona norte de México que en el resto del país, estando documentada solamente en ciudades que están localizadas exactamente en la frontera entre México y EE.UU. El marco legal mexicano está centrado en la rehabilitación, sin embargo sus efectos en las vidas de los consumidores son desconocidos. El objetivo de esta investigación fue analizar cómo se conceptualiza el marco regulatorio mexicano, y cómo se hace realidad en la vida diaria de un grupo de personas usuarias de heroína, procedentes de una ciudad del norte, donde recientemente el consumo se ha extendido y no se ha documentado. Nosotros recogimos datos oficiales registrados de consumidores y realizamos un estudio cualitativo en Hermosillo, Sonora. Se realizó una investigación sobre el marco legal, así como del contexto de la ciudad. Los datos sobre los consumidores de heroína sólo se pueden encontrar en centros de salud especializados en VIH, pues que no existe otra fuente para tales registros. El marco legal mexicano pretende la rehabilitación y evitar la criminalización; sin embargo, la vida diaria de los consumidores les conduce hacia los circuitos del crimen: la gente comete delitos para estar en prisión, donde pueden controlar la adicción y conseguir heroína, en caso de abstinencia. El estado mexicano no cuenta con información empírica para mejorar los programas y leyes relacionadas con el consumo de heroína. Las prácticas diarias de los consumidores se han convertido no sólo en riesgos epidemiológicas, sino tambiém en riesgos sociales para la comunidad y los propios consumidores. Asimismo, la falta de acceso debido a la estigmatización, la criminalización y la violencia, incrementa las inequidades, creando un círculo vicioso que reproduce la pobreza y el sufrimiento, como parte de la estructura social. Por ello, es necesario que se produzcan cambios en el sistema judicial.

Resumo: O consumo da heroína é baixo no México, comparado ao uso nos Estados Unidos, porém essa prática é mais comum na região Norte do México em comparação com o resto do país, sendo documentada apenas nas cidades localizadas justamente na fronteira com os Estados Unidos. A legislação mexicana visa principalmente a reabilitação, mas seus efeitos sobre a vida dos usuários não são conhecidos. Este estudo teve como objetivo analisar a maneira pela qual o arcabouço regulatório mexicano é conceituado e praticado na vida diária de um grupo de usuários de heroína de um município no Norte do México, onde o consumo tem sido disseminado recentemente, mas sem ter sido documentado até então. Foram coletados os dados oficiais sobre usuários, seguido por um estudo qualitativo em Hermosillo, no Estado de Sonora. Foram estudados a legislação pertinente e o contexto local em Hermosillo. Os dados sobre os usuários de heroína foram encontrados nos centros de atendimento a pessoas com HIV, uma vez que não existe outra fonte desses registros. A legislação mexicana visa a reabilitação dos usuários, evitando sua criminalização, mas sua vida cotidiana os empurra para os circuitos do crime. Assim, os indivíduos cometem crimes para permanecer na prisão, onde conseguem controlar a dependência e obter a droga em casos de síndrome de abstinência. O governo mexicano não dispõe de dados empíricos para melhorar os programas e leis relacionados ao uso da heroína. As práticas diárias dos usuários se transformam em riscos, não apenas epidemiológicos como também sociais, tanto para a comunidade quanto para os próprios usuários. Além disso, a falta de acesso a serviços, em função da combinação de estigmatização, criminalização e violência, aumenta as desigualdades, criando um ciclo que reproduz e o sofrimento enquanto parte de uma estrutura social. Portanto, são necessárias mudanças urgentes no sistema de justiça.

Physical Therapy.

Physical therapy has the evidence-based science knowledge to address a wide range of physical and psychological problems of addiction. Neuromodulation techniques are becoming more and more important in the treatment of addiction. Here, the efficacy of different neuromodulation techniques in addiction, such as transcranial direct current stimulation (tDCS), repetitive transcranial magnetic stimulation (rTMS), deep brain stimulation (DBS), is critically evaluated. Other physical therapy methods including Biofeedback, Physical Activity and Acupuncture are also presented.

Traditional Chinese Medicine (TCM) Therapy.

Traditional Chinese Medicine(TCM) has been utilized in China for more than 2,000 years, and it has been practiced in treatment of substance addiction and non-substance addictions. TCM have efficacy in the rehabilitation of abnormal physical problems induced by chronic drug use, including improving immune function, increasing working memory, and protecting against neurological disorders. Given that TCM is potentially effective in the prevention of relapse, it has been suggested that TCM may be the ideal choice in the future for the treatment of opiate addiction. This review examines the significance of effective Chinese herbs and prescriptions for Drug Addiction, Alcohol addiction and food addiction.

Nutrition Support Therapy.

In most addictions, serious nutritional deficiencies of major proteins, fats, vitamins and minerals exist which prevent their capability to digest carbohydrates efficiently. This review aims to point out some treatment approaches in nutrition management for alcohol addiction, drug addiction, food addiction, Internet addiction and sex addiction, according to existing literatures.

Why People Who Inject Drugs Voluntarily Transition Off Methadone in Ukraine.

Methadone maintenance therapy (MMT) treats opioid use disorder among people who inject drugs (PWID). To understand why PWID may voluntarily discontinue MMT, we analyzed data from 25 focus groups conducted in five Ukrainian cities from February to April 2013 with 199 participants who were currently, previously, or never on MMT. Using constant comparison method, we uncovered three themes explaining why PWID transition off MMT: (a) purposeful resistance to rigid social control associated with how MMT is delivered and to power asymmetries in provider-patient relationships, (b) self-management of a PWID's "wounded identity" that is common in socially stigmatized and physically sick persons-MMT serves as a reminder of their illness, and (c) the quest for a "normal life" uninterrupted by daily MMT site visits, harassment, and time inefficiencies, resources, and social capital. Focusing on holistic principles of recovery would improve addiction treatment and HIV prevention in Ukraine and globally.