Epidemiology of acute infections in people who inject drugs in Australia.

ISSUES: People who inject drugs are at risk of acute infections, such as skin and soft tissue infections, infective endocarditis, bone and joint infections and bloodstream infections. There has been an increase in these infections in people who inject drugs internationally over the past 10 years. However, the local data regarding acute infections in Australia has not been well described. APPROACH: We review the epidemiology of acute infections and associated morbidity and mortality amongst people who inject drugs in Australia. We summarise risk factors for these infections, including the concurrent social and psychological determinants of health. KEY FINDINGS: The proportion of people who report having injected drugs in the prior 12 months in Australia has decreased over the past 18 years. However, there has been an increase in the burden of acute infections in this population. This increase is driven largely by skin and soft tissue infections. People who inject drugs often have multiple conflicting priorities that can delay engagement in care. IMPLICATIONS: Acute infections in people who inject drugs are associated with significant morbidity and mortality. Acute infections contribute to significant bed days, surgical requirements and health-care costs in Australia. The increase in these infections is likely due to a complex interplay of microbiological, individual, social and environmental factors. CONCLUSION: Acute infections in people who inject drugs in Australia represent a significant burden to both patients and health-care systems. Flexible health-care models, such as low-threshold wound clinics, would help directly target, and address early interventions, for these infections.

Trilhas nômades nordestinas de cuidado entre GAM e redução de danos / Northeastern nomad care trails between GAM and harm reduction / Senderos nómados nordestinos de cuidado entre GAM y reducción de daños

O presente trabalho tem por objetivo cartografar as potencialidades do encontro entre a estratégia da Gestão Autônoma da Medicação (GAM) com a perspectiva ético-política da Redução de Danos, a partir da experiência de um grupo GAM no Centro de Atenção Psicossocial para Álcool e Outras Drogas (Caps-Ad) da cidade de Garanhuns-PE. Nos valemos de diários de campo produzidos durante o grupo e, depois, em retorno ao campo para atualização da experiência. Os diários auxiliaram na composição de narrativas de análise com foco nas práticas de cuidado de si e nos efeitos do grupo nas trajetórias dos atores envolvidos e do serviço. Conclui-se que a estratégia GAM enriquece e amplia o paradigma da Redução de Danos, potencializando o cuidado integral aos que usam drogas e gerando efeitos de autonomia e emancipação nas trajetórias de cuidado e vida. (AU)

The present work aims to map the potential of the clash between the Autonomous Medication Management (GAM) strategy with the ethical-political perspective of Harm Reduction, based on the experience of a GAM group at the Psychosocial Care Center for Alcoholand Others Drugs (Caps-Ad) in the city of Garanhuns-PE. We made use of field diaries produced during the group and, later, back in the field to update the experience. The diaries helped in the composition of analysis narratives focusing on Self-Care practices and on the effects of the group on the trajectories of the actors involved and on the service. It is concluded that the GAM strategy enriches and expands the Harm Reduction paradigm, enhancing comprehensive care for drug users and generating effects of autonomy and emancipation in care and life trajectories. (AU)

El presente trabajo tiene como objetivo mapear el potencial del encuentro entre la estrategia de Gestión Autónoma de Medicamentos (GAM) con la perspectiva ético-política de Reducción de Daños, a partir de la experiencia de un grupo GAM del Centro de Atención Psicosocial de Alcohol y Otras Drogas (Caps-Ad) en la ciudad de Garanhuns-PE. Hicimos uso de diarios de campo elaborados durante el grupo y, posteriormente, de vuelta en el campo para actualizar la experiencia. Los diarios ayudaron en la composición de narrativas de análisis centradas en las prácticas de autocuidado y en los efectos del grupo en las trayectorias de los actores involucrados y el servicio. Se concluye que la estrategia GAM enriquece y amplía el paradigma de Reducción de Daños, potenciando la atención integral a los usuarios de drogas y generando efectos de autonomía y emancipación en el cuidado y en las trayectorias de vida. (AU)

A qualitative study of professionals' perspectives on the ethics of medically-delivered safer injection education for people who inject drugs.

BACKGROUND: In this qualitative analysis we aimed to explore addiction physicians' perspectives on safer injection education for people who inject drugs, especially: (1) on possible means of introducing safer injection education in the medical environment, (2) on the compatibility of safer injection education with each physician's core values and goals, and (3) on possible reasons for the ethical dilemma in safer injection education. METHODS: We conducted semi-structured interviews with eleven physicians practicing addiction medicine in France in clinical and harm reduction settings. RESULTS: All participants were in favor of educational interventions for people who inject drugs. Nonetheless, these interventions varied from simple advice to injection supervision and they were seen as less acceptable when they concerned the practical and material aspects of injection. Some participants found that physicians practicing in clinical settings, where patients consult mostly to stop their drug use, should not practice safer injection education. On the contrary, other participants claimed that safer injection education was essential in all settings and was not a choice but rather a duty for addiction physicians. The ethical dilemma of such intervention when delivered by medical staff was viewed as a complex phenomenon, related to the representations of intravenous drug use and to societal expectations from physicians. CONCLUSION: Physicians' views on safer injection education for people who inject drugs reveal an emotionally charged subject related to the structural organization of addiction management in France. Such education is marked by an arduous history of harm reduction policies in France. IRB REGISTRATION: #00011928.

Causes and risk factors of death among people who inject drugs in Indonesia, Ukraine and Vietnam: findings from HPTN 074 randomized trial.

INTRODUCTION: The HIV Prevention Trials Network (HPTN) 074 study demonstrated a positive effect of an integrated systems navigation and psychosocial counseling intervention on HIV treatment initiation, viral suppression, medication assisted treatment (MAT) enrollment, and risk of death among people who inject drugs (PWID). In this sub-study, we analyzed the incidence, causes, and predictors of death among HIV-infected and uninfected participants. METHODS: The HPTN 074 randomized clinical trial was conducted in Indonesia, Ukraine, and Vietnam. HIV-infected PWID with unsuppressed viral load (indexes) were recruited together with at least one of their HIV-negative injection partners. Indexes were randomized in a 1:3 ratio to the intervention or standard of care. RESULTS: The trial enrolled 502 index and 806 partner participants. Overall, 13% (66/502) of indexes and 3% (19/806) of partners died during follow-up (crude mortality rates 10.4 [95% CI 8.1-13.3] and 2.1 [1.3-3.3], respectively). These mortality rates were for indexes nearly 30 times and for partners 6 times higher than expected in a population of the same country, age, and gender (standardized mortality ratios 30.7 [23.7-39.0] and 5.8 [3.5-9.1], respectively). HIV-related causes, including a recent CD4 < 200 cells/µL, accounted for 50% of deaths among indexes. Among partners, medical conditions were the most common cause of death (47%). In the multivariable Cox model, the mortality among indexes was associated with sex (male versus female aHR = 4.2 [1.5-17.9]), CD4 count (≥ 200 versus < 200 cells/µL aHR = 0.3 [0.2-0.5]), depression (moderate-to-severe versus no/mild aHR = 2.6 [1.2-5.0]) and study arm (intervention versus control aHR = 0.4 [0.2-0.9]). Among partners, the study arm of the index remained the only significant predictor (intervention versus control aHR = 0.2 [0.0-0.9]) while controlling for the effect of MAT (never versus ever receiving MAT aHR = 2.4 [0.9-7.4]). CONCLUSIONS: The results confirm that both HIV-infected and uninfected PWID remain at a starkly elevated risk of death compared to general population. Mortality related to HIV and other causes can be significantly reduced by scaling-up ART and MAT. Access to these life-saving treatments can be effectively improved by flexible integrated interventions, such as the one developed and tested in HPTN 074.

What's in Stock? Drug drought anticipation during COVID-19 among people who use drugs and service providers.

BACKGROUND: As with other areas of life, drug markets have been impacted by the COVID-19 pandemic and related restrictions. This article examines how structurally vulnerable people who use drugs (PWUD) experienced and adapted to changes in street drug markets caused by lockdown measures. METHODS: The article builds on ethnographic fieldwork in two Danish cities in 2020, including in-depth interviews with 22 PWUD, and interviews with 20 service providers, including low-threshold service providers and outreach workers. RESULTS: The most consistently reported effect of lockdown measures on local drug markets related to increases in cannabis prices. Accounts of changes in drug availability varied greatly, with some participants reporting changing availability while others described the situation as similar to pre-lockdown conditions. Rather than a long-term drug shortage, changes reported by participants related to the anticipated disruption of local markets and drug scarcity, restrictions in access to cash and sellers seeking to capitalize on the crisis. CONCLUSION: Although no long-term drug scarcity was seen, the anticipation of a shortage was sufficient to impact on local drug market dynamics. Heterogeneity in PWUDs' experiences of access to drug markets during lockdown can to some degree be explained in terms of their varied embeddedness in social networks. While local markets proved resilient to lockdown measures, PWUD less embedded in social networks were more vulnerable to shifts in drug availability and to sellers' over-pricing of drugs.

The Journey From Drug Addiction to Drug Withdrawal: A Christian Gospel Rehabilitation Program in Taiwan.

BACKGROUND: World Drug Report estimates the number of opioid users at 53 million and identifies opioids as responsible for two thirds of the 585,000 people who died as a result of drug use in 2017. PURPOSE: The purpose of this study was to analyze the testimonies of 30 people regarding their journeys from drug addiction to drug withdrawal in Taiwan. METHODS: This was a qualitative research design. The sample inclusion criteria were as follows: (a) being a drug abuser, (b) completed the Christian Gospel Drug Withdrawal Program or church-sponsored program, and (c) shared their related testimony on the Good TV television channel in Taiwan. The participants' stories were posted in Chinese, transcribed by the author, and translated from Chinese into English. Content analysis was used to identify the major themes. RESULTS: Of the 30 participants, 24 were male (80%) and six were female (20%). The major themes identified in their testimonies were: (a) Using illegal drugs related to peer recognition, lack of knowledge, and temptations; (b) drug addiction was an endless pain cycle; (c) turning points related to love, repentance, and hope; (d) drug withdrawal was related to avoiding temptation and overcoming the drug withdrawal syndrome through the Holy Spirit; and (e) outcomes were faith and new life. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: In this study, people who received the gospel drug withdrawal programs expressed that their lives had changed, they had withdrawn from drugs successfully, they had become volunteers to help others, and interactions with their family had improved. These programs may be applied in the mental health nursing profession.

'My mind pretty much went to mush': A qualitative exploration of trenbolone in the performance and image enhancing drug community.

INTRODUCTION: There are a variety of harms associated with anabolic-androgenic steroids (AAS), with some AAS associated with an increased risk profile for users. Despite potentially different risk profiles, these harms are seldom discussed with respect to specific compounds although recent ethnographic research has identified a need to do so. Specifically, myth has developed among users with trenbolone reportedly having more dramatic effects on individuals, with reports of aggression, violent behaviour and extreme mood disturbances, and this is reflected in extant literature. This paper aims to report on the narrative surrounding the use of trenbolone among AAS users. METHOD: As part of a larger qualitative study, a number of AAS users were interviewed regarding their usage practices. A narrative emerged regarding the physical and psychological harms which accompanied their AAS use of which trenbolone played a central role (N = 16). RESULTS: Of all the AAS, trenbolone was viewed as having the most deleterious consequences for those who used it. Users reported an extreme shift in risk profile for psychosocial harms, particularly increased aggression and violent behaviour, as well as impulsivity regulation issues. AAS-using peers and family members of users reported the readily observable effect of trenbolone. DISCUSSION AND CONCLUSIONS: Users should be cognisant of the potential for significant harms and health-care providers working with this group may consider more focused screening strategies. Future policy decisions regarding AAS may wish to consider the pivotal role trenbolone plays in adverse outcomes for this unique group of substance users.

HIV treatment, antiretroviral adherence and AIDS mortality in people who inject drugs: a scoping review.

BACKGROUND: People who inject drugs (PWID) are a key population for the prevention and care of HIV infection. METHODS: This scoping review covers recent (post-2010) systematic reviews on engagement of PWID in sequential stages of HIV care from uptake, to achieving viral suppression, and to avoiding AIDS-related mortality. RESULTS: We found that data on engagement of PWID into antiretroviral therapy (ART) were particularly scarce, but generally indicated very low engagement in ART. Studies of adherence and achieving viral suppression showed varying results, with PWID sometimes doing as well as other patient groups. The severity of social, medical and psychiatric disability in this population poses significant treatment challenges and leads to a marked gap in AIDS mortality between PWID and other population groups. CONCLUSIONS: Given the multi-level barriers, it will be difficult to reach current targets (UNAIDS fast-track targets of 95-95-95) for ART for PWID in many locations. We suggest giving priority to reducing the likelihood that HIV seropositive PWID will transmit HIV to others and reducing morbidity and mortality from HIV infection and from other comorbidities.

Prospective Memory, Sustained Attention and Response Inhibition in Poly-Substance Users Stable on Methadone Maintenance Treatment.

Background: Prospective memory and response inhibition are interrelated constructs, though studied separately in the drug addiction literature. Also, although sustained attention underlies response inhibition, its role in the relation between these functions has been largely neglected. The limited research on the cognitive effects of methadone-maintenance treatment (MMT) further stresses the importance of investigating these effects. Objective: Therefore, the current study focused on possible effects of MMT combined with long-term drug abuse on all these functions. Thirty five long term opiate/poly-substance users in MMT and thirty four drug-free controls were screened for socioeconomic status, anxiety, depression and general, non-verbal intelligence and then tested on a self-report measure of prospective memory and on the Go/No-Go task. Results: Compared to controls, the MMT group scored worse in all functions assessed. Prospective memory scores were also negatively related to Go/NoGo accuracy scores. Conclusion: As predicted, (a) the MMT participants show impairments in prospective memory, sustained attention and response inhibition and (b) prospective memory, response inhibition and sustained attention are related constructs. The results of this study could inform current rehabilitation and relapse prevention cognitive training practices.

Contextual Parameters Associated with Positive and Negative Mental Health in Recreational Psychedelic Users.

Growing research exploring the utility of psychedelic substances suggests that they not only hold promise for clinical practice but may enhance mental health through recreational use as well. However, given the importance of set and setting for maximizing benefits and minimizing harms of drug use, it is important to develop a foundational understanding of the contextual factors associated with positive and negative mental health in psychedelic users. Accordingly, data were collected using an internet-based survey of psychedelic drug users (n = 511). Hierarchical regression analyses were used to explore to what degree life-time use, frequency of use, dose size, group use, intentions for use, and post-use integration predict mental health in psychedelic users. In particular, using psychedelics with high frequency and to cope with negative affect were found to predict negative mental health. Conversely, using psychedelics in a group setting, with self-expansive intentions, and integrating post-use were found to predict positive mental health. Findings suggest that recreational psychedelic use may either enhance or diminish mental health depending on the contextual parameters of use. Limitations and areas for further research are discussed.

Vivências e sentidos do uso prejudicial de álcool e outras drogas / Experiences and meanings of the harmful use of alcohol and other drugs / Experiencias y significados del consumo nocivo de alcohol y otras drogas

Objetivo: compreender os sentidos e as vivências de uso prejudicial de álcool e outras drogas, sob a ótica de usuários da Rede de Atenção Psicossocial. Método: estudo qualitativo, descritivo, exploratório, que entrevistou 13 participantes adultos nos meses de setembro a dezembro de 2019. A análise firmou-se nos aportes da análise de conteúdo temática de Bardin, resultando as categorias, perdas e fracasso na vida, culpa, dualismo vida e morte - das cinzas à fênix, recaída. Resultados: o uso de substâncias remete a perdas familiares, de moradia, trabalho, dignidade; a destruição, fracasso. A recaída denota falha, pecado; acarreta culpa, auto-estigma. O sofrimento trespassa as tentativas de buscar do cuidado; reverbera na perda do sentido da vida, no comportamento suicida ou na resiliência e esperança-equilibrista. Conclusão: a clínica ampliada deve valorizar a geografia afetiva dos usos e a redução de danos.

Objectives: to understand the meanings and experiences of harmful use of alcohol and other drugs, from the perspective of users of the Psychosocial Care Network. Method: qualitative, descriptive, exploratory study that interviewed 13 adult participants in the months from September to December 2019. The analysis was based on Bardin's thematic content analysis, resulting in the categories, loss and failure in life, guilt, life and death dualism - from ashes to phoenix, relapse. Results: substance use refers to loss of family, housing, work, dignity; destruction, failure. Relapse denotes failure, sin; it brings guilt, self-stigma. Suffering goes through the attempts to seek care; it reverberates in the loss of the meaning of life, suicidal behavior or resilience and hope-equilibrist. Conclusion: the expanded clinic must value the affective geography of uses and harm reduction.

Objetivos:comprender los significados y experiencias del uso nocivo de alcohol y otras drogas, desde la perspectiva de los usuarios de la Red de Atención Psicosocial. Método: estudio cualitativo, descriptivo, exploratorio, que entrevistó a 13 participantes adultos en los meses de septiembre a diciembre de 2019. El análisis se basó en el análisis de contenido temático de Bardin, resultando en las categorías, pérdida y fracaso en la vida, culpa, dualismo vida y muerte - de las cenizas al ave fénix, recaída. Resultados:el uso de sustancias se refiere a pérdidas familiares, vivienda, trabajo, dignidad; destrucción, fracaso. La recaída denota fracaso, pecado; conlleva culpa, autoestigma. El sufrimiento pasa por los intentos de buscar atención; reverbera en la pérdida del sentido de la vida, conducta suicida o resiliencia y esperanza-equilibrista. Conclusión: la clínica ampliada debe valorar la geografía afectiva de los usos y la reducción de daños.

Incremento de la ingesta de alcohol y drogas como estrategia de afrontamiento en trabajadores hospitalarios durante el brote de COVID-19: Estudio transversal / Self-reported increase in alcohol and drugs intake as a coping strategy in hospital workers during COVID-19 outbreak: A cross-sectional study

Las situaciones de estrés psicológico, como la actual pandemia COVID-19,pueden implicar un aumento del consumo de alcohol y otras drogas de abuso como estrategia inadecuada de afrontamiento en profesionales sanitarios. Esta investigación tiene como objetivo estudiar el incremento de la ingesta de alcohol y drogas de abuso en los trabajadores hospitalarios. Persigue también, mediante un análisis de regresión logística, definir qué perfil de trabajadores el más vulnerable a este comportamiento. Para ello se realizó un estudio transversal en un hospital terciario en Madrid, España, durante la primera oleada de COVID-19. Participaron en el estudio un total de 657 trabajadores del hospital, 536 de ellos sanitarios y 121 no sanitarios. La recogida de datos se realizó a través de una encuesta en línea que incluía preguntas sobre hábitos básicos de salud, condiciones del entorno laboral, datos sociodemográficos, así como la versión de 12 ítems del Cuestionario de Salud General. El 17,1%declaró haber aumentado su consumo de alcohol y/o drogas de abuso durante el período analizado. Se asoció a una mayor probabilidad de dicho incremento: sexo masculino (p = ,044), vivir sin personas dependientes a cargo (p = ,005), ser médico adjunto o residente (p = ,010), haber trabajado en primera línea de COVID (p = ,058), presentar malos hábitos nutricionales(p = ,004) y realizar autoprescripción de fármacos psicotrópicos para controlar la ansiedad y el insomnio (p = ,003). Un porcentaje significativo delos trabajadores hospitalarios ha aumentado su consumo de alcohol y drogas de abuso durante la primera oleada de la pandemia COVID-19, existiendo un perfil de mayor riesgo para esta práctica. (AU)

Situations of psychological stress, such as the current COVID-19 pandemic,could lead to an increase in the consumption of alcohol and other drugs ofabuse as an inadequate coping strategy in health workers. This study aimedto investigate the intake of alcohol and drugs of abuse in hospital workersduring the first wave of COVID-19. A further focus was to define the workerprofile most vulnerable to this behavior through a logistic regression analysis.A cross-sectional study in a tertiary hospital in Madrid, Spain, during the firstwave of COVID-19 was designed. Information was collected from a sample(n = 657) of healthcare workers (n = 536) and non-healthcare workers (n =121). An online survey (including questions about basic health habits, workingenvironment conditions, sociodemographic data, and the 12-item versionof the General Health Questionnaire as a measure of psychological wellbeing) was conducted. Increased consumption of alcohol and/or drugs ofabuse during the analyzed period of the pandemic was reported by 17.1%of workers. The following variables were associated with a higher probabilityof increased consumption of alcohol and/or drugs of abuse: male gender(p = .044), living alone or without dependents (p = .005), staff physician orresident (p = .010), having worked on the COVID frontline (p = .058), poornutritional habits (p = .004) and self-prescription of psychotropic drugs tomanage anxiety and insomnia (p = .003). A significant percentage of hospitalworkers increased their consumption of alcohol and drugs of abuse duringthe first wave of the COVID-19 pandemic. A professional risk profile can be defined for this practice. (AU)

Implications of deficit discourse in the conversations of a mother who requests forced treatment / Implicações do discurso do déficit nas conversas de uma mãe que solicita tratamento forçado / Implications du discours déficitaire sur les conversations d'une mère qui demande traitement forcé / Implicaciones del discurso del déficit en las conversaciones de una madre que solicita tratamiento forzado

Abstract This case study analyzes the implications of deficit discourse on the daily conversations of a mother who requested forced treatment for her son. Data were analyzed drawing on social construction, with an emphasis on positioning theory and deficit discourse. Two episodes displaying deficit discourse were analyzed: one about the son as someone who is powerless, coping with drug use and another about the mother as someone unable to help her son. A sample letter was constructed using relational discourse, which provided new understandings for practice. Results support the benefits of collaborative and relational approaches for people who use drugs and for the emotional support of families.

Resumo Este estudo de caso analisa as implicações do discurso do déficit nas conversas cotidianas de uma mãe que solicitou tratamento forçado para seu filho. Os dados foram analisados a partir da construção social, com ênfase na teoria do posicionamento e do discurso do déficit. Dois episódios foram analisados a partir do discurso do déficit: um sobre o filho como alguém que é impotente no enfrentamento do uso de drogas e outro sobre a mãe como alguém incapaz de ajudar seu filho. Foi construída uma carta ilustrativa a partir do discurso relacional, que proporcionou novos entendimentos para a prática. Os resultados corroboram os benefícios das abordagens colaborativas e relacionais para o suporte emocional de pessoas que usam drogas e suas famílias.

Résumé Cette étude de cas analyse les implications du discours déficitaire sur les conversations quotidiennes d'une mère qui a demandé traitement forcé pour son fils. Les données ont été analysées en s'appuyant sur la construction sociale, en mettant l'accent sur la théorie du positionnement et le discours déficitaire. Deux épisodes ont été analyses utilisant le discours déficitaire: l'un sur le fils en tant que personne impuissante face à l'usage de drogue, et l'autre sur la mère en tant que personne incapable d'aider son fils. Une lettre illustrative a été construit utilisant le discours relationnel, qui a fourni de nouvelles compréhensions pour la pratique. Les résultats confirment les avantages des approches collaboratives et relationnelles pour le soutien émotionnel des personnes qui consomment des drogues et leurs familles.

Resumen Este estudio de caso analiza las implicaciones del discurso del déficit en las conversaciones diarias de una madre que solicitó tratamiento forzado para su hijo. Los datos fueron analizados a partir de la construcción social, con énfasis en la teoría del posicionamiento y el discurso del déficit. Se analizaron dos episodios a partir del discurso del déficit: uno sobre el hijo como alguien que es impotente frente al uso de drogas y otro sobre la madre como alguien incapaz de ayudar a su hijo. Se construyó una carta ilustrativa utilizando el discurso relacional, que proporcionó nuevas comprensiones para la práctica. Los resultados respaldan los beneficios de los enfoques colaborativos y relacionales para el soporte emocional de las personas que usan drogas y sus familias.

Trends and distinct profiles of persons who inject drugs in the United States, 2015-2019.

Drug injection represents a major health problem in the US, with severe health consequences including the transmission of blood-borne infections. An examination of the most recent trends in drug injection is warranted by the fast-evolving drug epidemic and recent policy changes such as the federal funding ban on needle exchange programs. This research examines current drug injection trends, patterns, and socioeconomic and behavioral profiles of people who inject drugs (PWID). Data were derived from the 2002 to 2019 National Survey on Drug Use and Health (NSDUH). After examining the annual prevalence of drug injection since 2002, a latent class analysis was conducted to identify drug injection and other substance misuse patterns among PWID using the latest (2015-2019) NSDUH datasets. Associations between class membership and behavioral health comorbidities and treatment receipt were also assessed. The drug injection prevalence among US adults aged 18-64 increased from 0.21% in 2002/2004 to 0.36% in 2017/2019. Three distinctive groups were identified: the heroin injection group (45.2%), the methamphetamine injection group (28.0%), and the multi-drug injection group (26.8%). The methamphetamine injection group reported greater risks of experiencing serious psychological distress, suicidality, and limited substance use treatment. Special attention is needed for those who primarily injected methamphetamine. Programs to promote harm reduction and increase access to addiction treatment need to be expanded in at-risk communities while accounting for their distinct socioeconomic and drug use/misuse profiles.

Public injecting and its association with mental health and other drug-related outcomes among people who inject drugs in Iran.

BACKGROUND: Injecting in public places may increase the risk of drug and health-related harms among people who inject drugs (PWID). We examined the prevalence of public injecting and associations with non-fatal overdose, needle/syringe sharing, sexual health, and mental health among PWID in Iran. METHODS: Using respondent-driven sampling, we recruited 2684 PWID from 11 major cities between July 2019 and March 2020. We defined public injecting as injecting primarily in public places, such as streets, parks, or abandoned buildings. Multivariable logistic regression models assessed public injecting and its associated factors, as well as the association of public injecting with certain health outcomes. RESULTS: Of 2388 respondents, 69.6 % reported public injecting in the previous year. Self-identifying as men (adjusted odds ratio [aOR] = 4.21; 95 % confidence intervals [95 % CI]: 2.31, 7.65), homelessness (aOR = 6.81; 95 % CI: 5.10, 9.10), high injection frequency (aOR = 1.58; 95 % CI: 1.03, 2.44), and free needle/syringe uptake (aOR = 1.47; 95 % CI: 1.04, 2.07) were significantly associated with public injecting. Compared to PWID who primarily inject in non-public places, PWID who mostly used public places had significantly greater odds of reporting non-fatal overdose (aOR = 2.02; 95 % CI: 1.01, 4.02), needle/syringe sharing (aOR = 1.77; 95 % CI: 1.08, 2.90), unsafe sexual practices with casual sexual partners (aOR = 2.16; 95 % CI: 1.03, 4.55), suicidal ideation (aOR = 1.50; 95 % CI: 1.02, 2.21), and self-harm (aOR = 1.78; 95 % CI: 1.24, 2.54) in the last three months. CONCLUSION: These results suggest the potential utility of a safer injecting environment to mitigate the multiple harms associated with public injecting in Iran. Optimizing health and well-being of PWID necessitates integrating supervised injection facilities into the current harm reduction programs and services in Iran. Future studies should also consider the experiences of additional mental health harms associated with public injecting when exploring adverse health outcomes among PWID.

Stress, Marginalization, and Disruption: A Qualitative Rapid Situational Assessment of Substance Users and HIV Risk in Lebanon.

Lebanon is a diverse and dynamic nation of six million people that has experienced considerable disruption for the last two decades. The Syrian Civil War, which began in 2011, resulted in the displacement of 1.1 million Syrians to Lebanon. Today, Lebanon is the country with the largest per capita number of refugees in the world. In addition, the country experienced a social, economic, and political crisis in 2019 that destabilized the entire society-circumstances that were further complicated by COVID-19 pandemic. With all of the competing calamities in Lebanon, there has been limited scientific investigation into substance use and the risk of HIV infection among the country's population. To address this gap in knowledge, a qualitative rapid situational assessment (RSA) of substance use and risk of HIV infection in and around Beirut, the nation's capital, was conducted. The goal of this analysis is to describe the demographics and drug use patterns of this population, explore their HIV knowledge and risks, and build knowledge about their perceptions of and access to substance use treatment and other social services.

Effects of social skills training for drug users under treatment / Efeitos do treinamento em habilidades sociais para usuários de substâncias em tratamento / Efectos del entrenamiento en habilidades sociales para usuarios de sustancias en tratamiento

The Social Skills Training (SST) presents satisfactory results in different clinical and non-clinical populations. The objective of this study is to evaluate the effects of SST on the perception of quality of life of drug users under treatment in post-intervention and follow-up conditions. It is a quasi-experimental study. The instruments used in the study were: CHASO, EMES-M, Extensive Interaction Semi-structured Test and WHOQOL. The study sample was composed of forty male drug users who participated in SST in a Therapeutic Community. The results indicate a statistically significant increase in the ability of defending rights, dealing with and keeping calm upon criticism, with medium effect size on the ability to refuse requests, refuse drugs and quality of life (psychological domain). SST was found to contribute to the development of specific social skills and as a complementary strategy in the Therapeutic Community. (AU)

O Treinamento em Habilidades Sociais (THS) apresenta resultados satisfatórios em populações clínicas e não clínicas. Objetiva-se avaliar os efeitos do THS na percepção de qualidade de vida e habilidades sociais de usuários de substâncias em tratamento nas condições de pós-intervenção e follow-up. Trata-se de um estudo quase-experimental. Os instrumentos utilizados foram: CHASO, EMES-M, Teste Semiestruturado de Interação Extensa e WHOQOL. Participaram 40 homens usuários de substâncias que participaram do THS em uma Comunidade Terapêutica. Os resultados apontam para um aumento estatisticamente significativo nas habilidades de defesa de direitos, enfrentar e manter a tranquilidade diante das críticas, com tamanho de efeito médio nas habilidades de negar pedidos, recusar a droga e qualidade de vida (domínio psicológico). Identifica-se que o THS contribui no desenvolvimento de habilidades sociais específicas, sendo uma estratégia complementar do tratamento na Comunidade Terapêutica. (AU)

El Entrenamiento en Habilidades Sociales (EHS) proporciona resultados satisfactorios en poblaciones clínicas y no clínicas. El objetivo de este estudio fue evaluar los efectos del EHS en la percepción de la calidad de vida y las habilidades sociales de los usuarios de drogas bajo tratamiento en condiciones de post-intervención y seguimiento. Se trata de un estudio cuasi-experimental Los instrumentos utilizados fueron: CHASO, EMES-M, Test Semiestructurado de Interacción Extensiva y WHOQOL. La muestra del estudio se compuso por cuarenta varones usuarios de drogas que participaron en el EHS en una Comunidad Terapéutica. Los resultados apuntan a un aumento estadísticamente significativo en la capacidad de defensa de derechos, afrontar, mantener la tranquilidad frente a las críticas, con un tamaño de efecto promedio en la denegación de peticiones, rechazo de drogas y calidad de vida (dominio psicológico). Se comprueba que el EHS contribuye al desarrollo de habilidades sociales específicas como una estrategia complementaria de tratamiento en la Comunidad Terapéutica. (AU)

Economic Challenges and Behavioral and Mental Health Risks for Overdose during the COVID-19 Pandemic among People Who Inject Drugs.

People who inject drugs (PWID) are a population that disproportionately struggles with economic and mental health challenges. However, despite numerous reports of people globally experiencing new or exacerbated economic and/or mental health challenges during the COVID-19 pandemic, the literature on the effect of the pandemic on PWID and their risk for harm (e.g., overdose) remains sparse. The present study will describe reported changes during the pandemic in risk factors for drug overdose (including changes in mental health symptoms and care access) among PWID in Chicago, and it will examine associations between such risk factor changes and the experience of economic challenges during the pandemic. Participants from an ongoing longitudinal study of young PWID from the Chicago suburbs and their injection risk network members (N = 138; mean age = 28.7 years) were interviewed about changes in their experiences, substance use behavior, and mental health since the start of the COVID-19 pandemic. Bivariate cross tabulations were computed of each "overdose risk factor" with experiences of economic challenges during the pandemic. Fisher's Exact Tests were used to assess statistical significance. Adjusted logistic regression models were also conducted that controlled for sociodemographic characteristics, for time elapsed since the start of the pandemic, and for pre-pandemic income, homelessness, and injection frequency. Over half of our sample reported using alone more than usual during the pandemic, and over 40% reported using more than usual and/or buying drugs that were of a decreased purity or quality. Additionally, a large proportion of our sample (52.5% of those asked) reported more difficulty than usual accessing mental health care. Experiencing loss of a source of income during the pandemic was associated with using more drugs, using alone more, using a larger amount of drugs while using alone, wanting to stop using but being unable, and difficulty accessing mental health care. The preliminary associations found by the present study suggest that economic challenges or disruptions experienced during the pandemic are likely to increase risk for overdose among PWID experiencing such challenges, via changes in the above behaviors and/or conditions that are associated with risk for overdose. Intervention efforts should therefore be focused not only directly on overdose prevention, but also on assisting PWID with their economic challenges and helping them regain economic stability and access to services that may have been impeded by financial difficulty.

"The Drug Use Unfortunately isn't all Bad": Chronic Disease Self-Management Complexity and Strategy Among Marginalized People Who Use Drugs.

Self-management programs improve health outcomes and self-management is recommended for chronic conditions. Yet chronic disease self-management supports have rarely been applied to people who use drugs (PWUD). Thus, our objective was to explore self-management experiences among marginalized PWUD. We used community-based participatory methods and conducted qualitative interviews. Participants self-identified as having long-term and past year experience using non-prescribed drugs, one other chronic condition, and socioeconomic marginalization. We analyzed the data using reflexive thematic analysis. Although many participants considered drug use a chronic health issue, self-medicating with non-prescribed drugs was also a key self-management strategy to address other health issues. Participants also described numerous other strategies, including cognitive and behavioral tactics. These findings highlight the need for a safe supply of pharmaceutical-grade drugs to support self-management among marginalized PWUD. Self-management supports should also be tailored to address relevant topics (e.g., harm reduction, withdrawal), include creative activities, and not hinder PWUD's agency.

Sociodemographic and clinical profile of crack cocaine treatment-seeking individuals living in "Crackland", Brazil / Perfil sociodemográfico e clínico de indivíduos em busca de tratamento para o uso de crack que vivem na "Cracolândia"

OBJECTIVE: São Paulo's Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. METHODS: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. RESULTS: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. CONCLUSION: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.

OBJETIVO: Localizada em São Paulo, a Cracolândia é o maior e mais antigo cenário aberto de uso de drogas do Brasil. Ainda assim, pouco se sabe sobre o perfil dos indivíduos que vivem nessa região e buscam tratamento para crack. O objetivo deste estudo transversal foi descrever características demográficas e clínicas de usuários de crack vivendo na região da Cracolândia que estão em busca de tratamento. MÉTODOS: Noventa e oito indivíduos foram avaliados para transtornos por uso de substâncias do DSM-V, padrão de uso de substâncias, impulsividade e sintomatologia psiquiátrica. O uso recente de crack também foi determinado por meio de coleta de amostras toxicológicas. RESULTADOS: Os resultados indicaram grave vulnerabilidade social, com significativas prevalências de falta de moradia (46,9%), moradia instável (50%), desemprego (60,4%) e abandono escolar precoce (27,5%). A idade média de início do uso de crack foi de 20 anos (DP = 6,9) e a duração média do uso contínuo do crack foi de 15 anos (DP = 9,7). A maioria dos participantes apresentou alguma comorbidade psiquiátrica, particularmente transtorno por uso de álcool (87,8%), bem como altas taxas de sintomatologia psiquiátrica e impulsividade. Mais da metade da amostra relatou pelo menos uma tentativa anterior de tratamento por internação (73,5%) e ambulatorial (65,3%). CONCLUSÃO: Os achados desse estudo permitem um maior entendimento do perfil e das necessidades de usuários de crack vivendo na região da Cracolândia e podem ajudar serviços de saúde especializados em dependência química a promoverem uma assistência mais direcionada às demandas específicas dessa população.