Characterizing prescription opioid, heroin, and fentanyl initiation trajectories: A qualitative study.

We understand the current crisis of overdose deaths to be driven by widespread opioid use, characterized by distinct 'waves' of drug use. The first wave was driven by prescription opioids, the second by heroin, and the third by illicit, non-pharmaceutical fentanyl and fentanyl analogues (henceforth, fentanyl). The purpose of this study is to describe opioid initiation within each of the three waves from the perspective of people who use illicit opioids, with a focus on emerging pathways into fentanyl use. The authors recruited sixty people reporting past-30-day illicit opioid use in Dayton, Ohio. Participants completed a brief survey and a semi-structured in-depth qualitative interview, conducted from March to November 2020 with a total of 13 in-person and 47 virtual interviews. The qualitative interviews were transcribed in their entirety and analyzed thematically using NVivo 12. We noted supply-side changes as influencing trajectories in all three waves. However, we also noted differences in the experiences of prescription opioid and heroin initiation, with these trajectories influenced by pharmacological effects, pain management, curiosity, intergenerational use, pricing, and peers. In comparison, most participants were unaware that they were initiating fentanyl, and many reported overdosing with their first use of fentanyl. We identified a trajectory into fentanyl with limited to no prior heroin use among a few participants. The increased risk of overdose with initiation into fentanyl use further emphasizes the need for an expansion of naloxone distribution and the implementation of more comprehensive measures, such as overdose prevention centers, drug testing, and a safer supply. Further research on the dynamics of the ongoing overdose death crisis in the era of fentanyl and the 4th wave of the overdose crisis is critical in developing responsive prevention and intervention strategies.

Ethnic Discrimination and Self-rated Health among Hispanic Emerging Adults: Examining the Moderating Effects of Self-esteem and Resilience.

Exposure to ethnic discrimination has been conceptualized as a sociocultural stressor that is associated with lower self-rated health. However, this association remains understudied among Hispanics and less is known about constructs that may mitigate the effects of ethnic discrimination on self-rated health. Accordingly, this study aimed to (a) examine the association between ethnic discrimination and self-rated health among Hispanic emerging adults (ages 18-25), and (b) examine the extent to which self-esteem and resilience may moderate this association. A convenience sample of 200 Hispanic emerging adults from Arizona (n=99) and Florida (n=101) was recruited to complete a cross-sectional survey. Data were analyzed using hierarchical multiple regression and moderation analyses. Results indicate that higher ethnic discrimination was associated with lower self-rated health. Moderation analyses indicated that self-esteem functioned as a moderator that weakened the association between ethnic discrimination and self-rated health; however, resilience did not function similarly as a moderator. This study adds to the limited literature on ethnic discrimination and self-rated health among Hispanics and highlights that psychological factors, such as enhancing self-esteem, may help buffer the adverse effects of ethnic discrimination on health outcomes.

Syndemic Profiles for HIV, Hepatitis C, and Sextually Transmitted Infections Among Mexican American Women Formerly Affiliated with Youth Street Gangs.

We examine syndemic profiles of intimate partner violence, mental health, drug use, incarceration, and infectious diseases (HIV, HCV, and STIs) among a sample of adult Mexican American women who were affiliated with youth street gangs during adolescence through their relationships to boys and men. Latent class analysis included multiple factors along the following dimensions: intimate partner violence, drug use, mental illness, and incarceration. Five unique syndemic profiles were found with varying associations to HIV, HCV, and STI: (1) no syndemic, (2) intimate partner violence, no syndemic, (3) drug use, mental health, and incarceration syndemic, (4) intimate partner violence, drug use (without injection drug use), and mental health syndemic, and (5) intimate partner violence, drug use with injection drug use, mental health, and incarceration syndemic. To successfully prevent HIV, HCV, and STI among gang-involved girls and women, it is necessary to address syndemic factors.

The opioid epidemic among the Latino population in California.

Background: The opioid epidemic in the United States has manifested differently across geographic regions and populations, with recent increases among racial/ethnic minorities and in the Western region of the U.S. This study provides an overview of the opioid overdose epidemic among Latinos in California and highlights high-risk areas in the state. Methods: Using publicly available data from California, we examined trends in opioid-related deaths (e.g., overdose) and opioid-related emergency department (ED) visits among Latinos at the county-level, as well as changes in opioid outcomes overtime. Results: Opioid-related death rates among Latinos (mostly Mexican-origin) in California remained relatively stable from 2006-2016, but started to increase in 2017 peaking at an age-adjusted opioid mortality rate of 5.4 deaths per 100,000 Latino residents in 2019. Prescription opioid-related deaths, compared to heroin and fentanyl, have remained the highest over time. However, fentanyl-related deaths began to increase dramatically in 2015. Lassen, Lake, and San Francisco counties had the highest 2019 opioid-related death rates among Latinos. Opioid-related ED visits among Latinos have steadily increased since 2006 with a sharp increase in rates in 2019. San Francisco, Amador, and Imperial counties had the highest 2019 rates of ED visits. Conclusions: Latinos are facing detrimental consequences associated with recent increasing trends in opioid overdoses. The identified high-risk counties may have vulnerable sub-populations of Latinos, such as those in northern rural regions, that have gone underrepresented in conventional surveillance health databases. Time sensitive policies and interventions are needed to curtail health consequences especially among "hidden" Latino populations.

Examination of multilevel domains of minority stress: Implications for drug use and mental and physical health among Latina women who have sex with women and men.

There has recently been growing attention and concern in the U.S. on the detrimental drug use and related health conditions impacting diverse sexual minority populations. While some evidence indicates that bisexual women are at increased risk of substance use, little attention has been given to disadvantaged and racial/ethnic minority bisexual women, who are particularly vulnerable to a complexity of stressors and risk. Using data from a 15-year longitudinal study in San Antonio, Texas, the current study examines drug use, incarceration histories, stressful life events, and infections among 206 young adult Mexican-American women who report engaging in sex with both men and women (WSWM) (n = 61) and those indicating having exclusively male sex partners (WSM) (n = 145). A bivariate analysis finds that WSWM experienced more frequent (p = 0.001) and longer total time incarcerated (p = 0.001), as well as exposure to more stressful life events (p = 0.003). WSWM also have higher rates of past 30 day injection drug use (p = 0.026) and related Hepatitis C Virus (HCV) infection (p = 0.001), as well as greater symptomatology associated with depression (p = 0.014), PTSD (p = 0.005), and suicidal ideation (p = 0.036). Findings indicate a significantly elevated risk profile for socio-economically marginalized WSWM. This knowledge is timely and central to policy discourse to develop interventions and health campaigns aimed at reducing and/or preventing further health disparities among this highly susceptible population of minority women.

"They Dumped Me Like Trash": The Social and Psychological Toll of Victimization on Latino Day Laborers' Lives.

Although recent rhetoric links undocumented immigrants to criminality, reports indicate undocumented immigrants commit less crime than their native-born counterparts and that this vulnerable group may be at increased risk for criminal victimization. Immigrants living in new immigrant settlement cities may be particularly at risk for exposure to criminal victimization due to the vulnerabilities associated with a lack of an established Latino community and limited availability of culturally appropriate social services to provide support. This ethnographic study examines the experiences of victimization and its social and psychological toll of a street-recruited sample of Latino day laborers (LDLs) (N = 25) living and working in Baltimore, a new immigrant settlement city. Findings elucidate and describe the specific types of victimization experienced by LDLs, including workplace victimization (wage theft, abandonment at the jobsite, poor working conditions, verbal abuse) and street-level victimization (assault and robbery), as well as reveal the social and psychological toll of victimization (sociocultural alienation, despair or desesperación, and problem drinking) on their lives. Findings have implications for community psychology, through research and practice, as they provide insights for prevention and intervention within the intersection of structural vulnerability (i.e., undocumented immigration status), violence, and mental health.

Organizational factors associated with practitioners' support for treatment of opioid use disorder in the emergency department.

BACKGROUND: Despite the significant increase in emergency room visits for opioid overdose, only few emergency departments (ED) have implemented best practices to treat people with opioid use disorders (OUD). Some implementation gaps may be due to practitioner factors; such as support for medication-assisted treatment (MAT) for OUD in the ED. In this study, we explore the relationship between inner setting characteristics of the EDs (e.g., leadership, readiness for change, organizational climate) and practitioner support for OUD treatment and attitudes towards people with OUD. METHODS: We surveyed 241 ED practitioners (e.g., physicians, nurses, social workers) at one of the largest EDs in the United States. We used analysis of variance and chi-square global tests to compare responses from ED practitioners in differing roles. We also conducted five multivariate logistic regressions to explore associations between ED inner setting characteristics and five antecedents of implementation; ED practitioner (1) supports MAT for OUD in the ED, (2) supports best practices to treat OUD, (3) has self-efficacy to treat OUD, (4) has stereotypes of people who use drugs, and (5) has optimism to treat people with OUD. RESULTS: We found nurses were more likely than physicians to support MAT for OUD in the ED and delivering other best practices to treat OUD. At the same time, nurses had greater bias than physicians against working with patients suffering from OUD. We also found the ED's climate for innovation and practitioners' readiness for change were positively associated with support for MAT for OUD in the ED and using best practices to treat OUD. CONCLUSIONS: Findings suggest that professional roles and some ED inner setting factors play an important role in antecedents of implementation of OUD treatment in the ED. To prepare EDs to effectively respond to the current opioid overdose epidemic, it is critical to further understand the impact of these organizational factors on the implementation of evidence-based OUD treatment practices in the nation.

Trajectories of heroin use: A 15-year retrospective study of Mexican-American men who were affiliated with gangs during adolescence.

BACKGROUND: Heroin use is a public health concern in the United States. Despite the unique etiology and patterns of heroin use among U.S. Latinos, long-term heroin trajectories and health consequences among Latinos are not well understood. This study aims to document the distinct heroin use trajectories for a group of street-recruited (non-treatment), young adult Mexican American men living in a disadvantaged community who were affiliated with gangs during their youth. METHODS: One-time interviews conducted between 2009-2012 in San Antonio, TX collected retrospective data from a sample of 212 Mexican American young adult men who reported using heroin at least once. Group-based trajectory modeling was applied to determine discrete developmental trajectories of heroin use. ANOVA, Chi square tests, and multinomial logistic regression examined current (past year) social and health indicators among each trajectory group. RESULTS: Five discrete heroin trajectories groups were identified: low use (n = 65); late accelerating (n = 31); early decelerating (n = 26); late decelerating (n = 38); and stably high (n = 52). Varying social and health consequences were found among the trajectory groups. CONCLUSION: This study describes the unique heroin use trajectories and social and health outcomes among a high-risk subgroup of Mexican American men. The findings suggest that early intervention and intervention available in easy to access non-treatment spaces may be especially useful for groups of people who use relatively less heroin.

Interpersonal Partner Relationships, Bonds to Children, and Informal Social Control among Persistent Male Offenders.

This qualitative study applied a life course framework to characterize the nature of interpersonal partner relationships of Mexican American young adult men affiliated with street gangs during their adolescence. Data come from a 15-year longitudinal mixed-method cohort study conducted in San Antonio, Texas. We analyzed semi-structured interviews conducted with a subsample (n = 40) during the course of three face-to-face sessions to explore the men's motivations, aspirations, and goals to lead conventional lives, despite their criminal justice involvement. Specifically, we focus on the complex nature of maintaining ties to children, the navigation of complicated family structures, the processes of seeking partners with economic resources, and on partnerships with criminal and delinquent partners. We document the complex interpersonal nature of these relationships as men contend with serial incarceration and their desires and motivations to desist from criminal behavior.

Safer Crack Kits and Smoking Practices: Effectiveness of a Harm Reduction Intervention among Active Crack Users in Mexico City.

BACKGROUND: Crack cocaine use has increased rapidly throughout Mexico, coinciding with rising HIV and HCV infections among vulnerable groups. Due to the increased risk of infection among crack users, harm reduction approaches have been identified to reduce the spread of disease. However, Mexico has yet to adopt these techniques for crack users. OBJECTIVES: To evaluate the impact of a pilot crack kit distribution program on risky smoking behaviors of active crack users in an impoverished colonia of Mexico City, Mexico. METHODS: Fifty crack kits, containing safer smoking paraphernalia and related health items (i.e., condoms, alcohol wipes, etc.), were distributed to active crack users. A sample of 58 crack users were surveyed prior to the intervention and 35 were successfully relocated and surveyed three months after the intervention. Surveys assessed drug use, crack kit utilization, and smoking practices. RESULTS: Findings indicate that crack kit utilization was high throughout the sample. Use of risky or unsafe paraphernalia decreased, specifically the use of cans as pipes (Z = -2.653, p = .008). Similarly, Pyrex pipe use increased significantly (Z = -3.132, p = .002). Sharing of paraphernalia also decreased throughout the sample. CONCLUSION: These findings identify the potential benefits in reducing risky smoking behaviors of crack kit distribution programs in Mexico City. This evidence supports expansion of crack kit programs in Mexico and similar impoverished regions.

Behavioral, Psychological, Gender, and Health Service Correlates to Herpes Simplex Virus Type 2 Infection among Young Adult Mexican-American Women Living in a Disadvantaged Community.

Herpes simplex virus type 2 (HSV-2) is among the most prevalent sexually transmitted infections in the United States. Despite this, there has been limited research on the correlates to HSV-2 among disadvantaged and marginalized women, particularly among Latinas. Data for the present analysis include 125 young adult Mexican-American women enrolled in a longitudinal study in a disadvantaged urban community in San Antonio, Texas. The current rate of tested HSV-2 infection is 56.8%. Our findings suggest strong comorbidity of genital herpes with injecting heroin use, Hepatitis C, sexual violence, incarceration, and mental illness. Contributing to this population's nexus of risk are the low rates of health service utilization among those infected with HSV-2. Integration between behavioral health and primary care, including access to preventative services, are essential for improving the health of Latinas living in disadvantaged neighborhoods.

History of child sexual abuse among women consuming illicit substances in Mexico City.

INTRODUCTION: Child sexual abuse (CSA) is a pervasive problem that has been linked to numerous developmental, social, health, and substance use consequences. Nevertheless, the relationship between CSA and the consumption of psychoactive substances has not been adequately studied in Mexico. The present study aims to examine this association between history of CSA and illicit substance use and associated risk behaviors in a sample of young adult women in Mexico City. DESIGN AND METHODS: The present study uses a cross-sectional design to examine sexual abuse history among women who use illicit substances. Data collection consisted of a questionnaire administered through face-to-face interviews with 101 women who sought treatment for substance use in Mexico City. A bivariate analysis was used to examine women who experienced sexual abuse and those who did not. Odds ratio and relative risk were estimated. RESULTS: A total of 101 women were interviewed with an average age of 19.2 years. The average age of onset of drug use was 15.4 years. Among participants, 68% reported having been victims of sexual abuse and rape. The average age of reported sexual abuse was 12.2 years. Participants reported a high rate of polydrug use (32.7%), consuming more than two drugs. Sexual abuse was associated with detention by police for drugs, forced prostitution, and consumption of substances during pregnancy. DISCUSSION AND CONCLUSIONS: This study found that sexual abuse and rape were highly associated with substance abuse outcomes and associated risk behaviors.

Biological Risk and Infection Profiles of Young Adult Male Mexican American Gang Members.

OBJECTIVES: Little research has examined the long-term health consequences of gang affiliation among Mexican Americans. The objectives of this study were to (1) measure biological indicators of cardiovascular and metabolic risk, as well as prevalence of sexually transmitted infections (STIs), in a sample of Mexican American men aged 25-40 who were affiliated with gangs as adolescents and (2) compare those indicators with a comparable national sample of Latino men. METHODS: Using bivariate analyses, we compared blood pressure, body mass index, 4 metabolic and cardiovascular indicators, and 4 infections for 179 Mexican American formerly gang-affiliated men in San Antonio, Texas, and 155 Mexican American men from the National Health and Nutrition Examination Survey. We used multivariate models to estimate adjusted risk scores for each sample controlling for age, marital status, and education. RESULTS: Compared with men in the national sample, the unadjusted results showed that men in the gang-affiliated sample had significantly higher mean systolic blood pressure (125.6 vs 120.0 mm Hg, P = .001), diastolic blood pressure (81.4 vs 71.1 mm Hg, P < .001), and C-reactive protein (5.9 vs 3.6 mg/L, P = .04), and a significantly lower mean total cholesterol (164.2 vs 205.5 mg/dL, P < .001) and low-density lipoprotein cholesterol (91.1 vs 120.1 mg/dL, P < .001). Compared with men in the national sample, more men in the gang-affiliated sample had herpes simplex virus type 2 (64/174 [36.8%] vs 18/147 [12.2%], P < .001), chlamydia (10/176 [5.7%] vs 1/135 [0.7%], P = .02), and hepatitis C virus (85/173 [49.1%] vs 0, P < .001). The gang-affiliated sample had a significantly higher adjusted risk score than the national sample (1.5 vs 1.1, P = .003). CONCLUSIONS: Gang-affiliated Mexican American men had significant disparities in biological risk indicators and STIs, which can lead to long-term health implications and highlight the need for tailored prevention strategies. Long-term exposure to psychosocial stressors and subsequent systemic inflammation may also increase the risk for physiological and psychological dysregulation and detrimental chronic health conditions in this population.

Mental health of heroin users with differing injection drug use histories: A non-treatment sample of Mexican American young adult men.

BACKGROUND: While the comorbidity of mental health and injecting heroin has been documented, current research is limited by describing the mental health of people who inject drugs without a comparison group and by the lack of research on nontreatment samples in the United States, particularly among Hispanics. The purpose of this study was to examine the association of injecting history (never, former, occasional, and daily) and multiple outcomes of global and mental health using a sample of U.S.-based Latinos not currently in treatment. METHODS: Data are from a sample of street-recruited Mexican American young adult men (n=275) in San Antonio, TX. Multiple logistic regression and structural equation modeling were used. RESULTS: Overall 54% of men reported lifetime injecting drug use (20.7% former users, 11.1% occasional users, and 21.9% daily users). We found varying prevalence rates of global and mental health status among different histories of injecting. After covariate adjustment, daily injecting remained strongly associated with all four outcomes: perceived poor health status (AOR=4.39; p≤0.001), psychological distress (AOR=2.78; p≤0.05), depression (AOR=4.37; p≤0.001), and suicidal ideation (OR=4.75; p≤0.001). Acculturation, gang membership, and incarceration history also emerged as important factors. CONCLUSION: This study provides new information about the relationship between mental health and injecting heroin use. FINDINGS: Support the need to consider mental health states among people who inject drugs, and to examine varying histories of injecting with socially and culturally relevant factors.

HIV and STI knowledge, testing, and risk among adult crack users in Mexico city: baseline findings from a feasibility study.

Recent research has documented crack cocaine's increasing spread in Mexico, which is likely to contribute to the rapid transmission of HIV and other sexually transmitted infections (STIs). In Mexico, crack use is increasing most rapidly in vulnerable, hard-to-reach populations, where little is known about risk behaviors. This report aims to present baseline data regarding HIV and STI knowledge and testing prevalence from an innovative projection mapping HIV intervention, in which 3-D illusions, animation, and visual text graphics and sound are projected onto buildings with health messages that were designed to disrupt everyday life and connect with the target population. Fifty-eight men and women who used crack in the past month without receiving drug treatment were recruited and interviewed before the projection mapping intervention took place. Testing instruments included a sociodemographic assessment, drug use and treatment profile, HIV and STI knowledge questionnaires, and a sex and drug risk assessment. The mean scores for respondents on the HIV Knowledge Questionnaire (10.5 out of 18, 58.3%) and STD Knowledge Questionnaire (9.5 out of 27, 35.2%) were both low. Respondents also reported high rates of sexual risk behaviors, with 73% reporting never using a condom and 64% never being tested for HIV. This report provides a portrait of STI and HIV risk among a vulnerable population in Mexico City and the need for urgent interventions to prevent the spread of STIs and HIV. The associated projection mapping intervention will seek to increase HIV and STI knowledge and reduce risk in this hard-to-reach population.

Risk Environments and Substance Use Among Mexican Female Sex Work on the U.S.-Mexico Border.

We use a risk environment framework to qualitatively examine pathways into substance use and abuse among Mexican female sex workers on the U.S.-Mexico border. Life history interviews and ethnographic observations were conducted with female sex workers to uncover how the border context shapes patterns of substance use. The findings illustrate that, for many women, initiation into sex work is contextualized within immigration, the global economy, and demands and desire for financial autonomy. Paradoxically, many find autonomy within sex work as they increase their ability to support their families and themselves. As women become more entrenched in sex work, however, they are put on a path toward substance abuse beginning with alcohol then cocaine and heroin. This identification of specific substance use pathways and trajectories has important implications for the development of prevention and intervention programs that can help curtail problematic drug use that can lead to negative health consequences.

Un Jalón, Un Volteón, y Otra Vez: High-Risk Crack Smoking Paraphernalia in México City.

During the past decade, crack smoking has increased in Mexico among poor urban populations. Despite this increasing prevalence, little is known about the types of paraphernalia used and related sharing practices and physical harms. Data come from in-depth semi-structured interviews and observations with 156 current crack smokers in Mexico City. Findings reveal a complex, crack-smoking process in Mexico City that represents an interconnected structure of paraphernalia items and pipes that could contribute to detrimental health consequences. Specifically, we identify essential paraphernalia items that make the smoking of crack possible; describe the homemade construction of two categories of pipes; and detail the sharing practices and physical harms associated with these paraphernalia. Results point towards a smoking process that is embedded in impoverished urban neighborhoods sustained by an accessible street-level crack market. Discussed are the policy and intervention implications associated with reducing crack-related health consequences in Mexico and other Latin American countries.

Precocious transitions and long-term heroin use outcomes: A longitudinal study of gang-affiliated Mexican-American males.

A longitudinal study (15years) investigates heroin use patterns following precocious transition experiences for gang-affiliated Mexican-American males (n=119) in San Antonio, Texas. Five precocious transitions are examined: cohabitation, early nest leaving, school dropout, teenage parenthood, and unemployment (while not in school). Half of these men used heroin over the follow-up period for an average of under 4years. Findings from a zero-inflated Poisson model indicate that while these transitions do not have a significant effect on initiation of heroin use, they do have an important influence on individual's drug trajectories once they have initiated. Early-nest leaving and teenage parenthood are protective factors for continued heroin use while dropping out of high school and cohabiting during this same period are risk factors. Findings are discussed within the context of these disadvantaged and marginalized communities.

Trajectories of Aging Long-Term Mexican American Heroin Injectors: The "Maturing Out" Paradox.

OBJECTIVE: To examine the applicability of the "maturing out" theory to a sample of aging Mexican American men who are long-term heroin injectors. METHOD: Ethnographic data were collected as part of a cross-sectional study of aging Mexican American heroin users in Houston with 20 current heroin users. RESULTS: Findings indicate that dysfunctions that emerge in the heroin lifestyle lead not to cessation but rather to "maturing in," a specific process of social readjustment that returns the heroin user to a stable maintenance pattern of use instead of a recovery phase. This process of paradoxical maturing out can be attributed to the unconditional social support provided to the heroin user by family, peers, and the tecato subculture embedded in Mexican American communities. DISCUSSION: Results highlight the implications for the intersection of heroin-related conditions, natural age-related impairments, and cognitive functioning that make this population increasingly susceptible to adverse health consequences.

Associations Between Long-Term Gang Membership and Informal Social Control Processes, Drug Use, and Delinquent Behavior Among Mexican American Youth.

Research has found that among juveniles weak ties to informal social control entities such as parents, school, and conventional peers increase the probability of the initiation and continuation of deviant behaviors such as drug use and crime. Given the weak ties of formal social control mechanisms in highly disadvantaged communities, informal social control mechanisms are often an important deterrent that reduce or moderate engagement in deviant behaviors among serious and persistent offenders. This analysis examines the association between long-term gang membership and adolescent informal social control processes, drug use, and delinquency. This research is based on data from a study of 160 Mexican American male gang members between the ages of 16 and 20. Findings suggest that among gang members in this context, commonly studied informal control mechanisms such as the family and schools do not function to deter long-term gang membership that is associated with serious criminal and violent behavior and drug use. The implications for future research on desistance or continuation of antisocial behavior across the life course are discussed.