Criminality and Sexual Behaviours in Substance Dependents Seeking Treatment

The aim of this study was to investigate the link between violence, crime, and sexual behavior among patients with substance-related disorder admitted to a specialized inpatient care unit. 

This was a cross-sectional study using a questionnaire on socio-demographic characteristics, drug of choice (DOC), questions about sexual behavior, and instruments to evaluate the severity of dependence (SADD, DAST, FTND), level of impulsivity (BIS-11), and a screening sex addiction scale. 

The sample consisted of 587 adult subjects, of which 

• 82.3% were men, 
• 66.4% had used cocaine (sniffed and smoked) as their DOC, 
• 24.4% had a history with the criminal justice system, 
• 26.8% had committed crimes, 
• 19.3% had engaged in violent behavior, and 
• 12.2% had been involved in drug trafficking. 

In this sample, crime was strongly associated with various sexual behaviors and the severity of substance dependence

Purchase full article at:   http://goo.gl/vuRtsA

By:  Diehl A¹, Pillon SC², Dos Santos MA³, Rassool GH⁴, Laranjeira R⁵.

¹a National Institute of Alcohol and Drugs Policy (INPAD), Psychiatrist, Federal University of São Paulo (UNIFESP) , Psychiatric Department , São Paulo , Brazil.

²b Professor, University of São Paulo (USP) , Psychiatric Nursing and Human Science Department, Faculty of Nursing at Ribeirão Preto, Ribeirão Preto, Brazil; PAHO/WHO Collaborating Centre for Nursing Research Development , Ribeirão Preto , Brazil.

³c Associate Professor, Faculty of Philosophy, Sciences and Letters of Ribeirão Preto , University of São Paulo, São Paulo , Brazil.

⁴d Professor and Executive Director, Sakina Counselling Institute , Port Louis , Republic of Mauritius.

⁵e Psychiatrist, Federal University of São Paulo (UNIFESP) , Psychiatric Department , São Paulo , Brazil.

J Psychoactive Drugs. 2016 Apr-Jun;48(2):124-134.

  

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Linkage to Primary Care for Persons First Receiving Injectable Naltrexone During Inpatient Opioid Detoxification

HIGHLIGHTS

• XR-NTX begun during opioid detoxification can be continued in primary care settings.
• 55% of XR-NTX recipients link to primary care for continued treatment.
• We found no predictors of XR-NTX continuation in primary care.

INTRODUCTION:

Opioid use disorders commonly require ongoing medication-assisted treatment to reduce relapse following discharge from inpatient detoxification programs. Naltrexone, an opioid antagonist, is an increasingly popular treatment option in its once-monthly injectable form (XR-NTX). The aim of this study was to examine the follow-up rates of persons who received an initial injection during inpatient detoxification and scheduled for receipt of a first outpatient injection in the primary care setting.

METHODS:

We reviewed the electronic health records of 62 consecutive opioid dependent adults who received an initial injection of XR-NTX during extended inpatient detoxification at Stanley Street Treatment and Resources (SSTAR) in Fall River, Massachusetts, from March 2013 to August 2015, and were referred to the adjacent SSTAR primary care health center for their second injection 1month later. Demographic information, drug use and opioid treatment history, and aftercare planning were assessed.

RESULTS:

Participants averaged 32.4 (±7.8) years of age, 90.3% were non-Latino Caucasian, 35.5% were homeless, 21.3% reported a drug overdose in the last year, and 53.2% had been in detoxification within the last year. Of the 62 participants referred to primary care, 34 (54.8%) followed up to receive their second XR-NTX injection. Twenty of these persons received at least a third XR-NTX injection. No demographic, treatment history, substance use behaviors, or aftercare plan variables were associated with receipt of a second injection (p<.20).

CONCLUSION:

Predicting, and therefore improving, XR-NTX continuation during the transition from inpatient detoxification to primary care may be difficult in this population.

Purchase full article at:   http://goo.gl/mEBWGY

By:  Stein MD1, Risi MM2, Bailey GL3, Anderson BJ2.

• 1General Medicine Research Unit, Butler Hospital, Providence, RI, 02906; Warren Alpert Medical School of Brown University, Providence, RI, 02912. Electronic address: michael_stein@brown.edu.
• 2General Medicine Research Unit, Butler Hospital, Providence, RI, 02906.
• 3Warren Alpert Medical School of Brown University, Providence, RI, 02912; Stanley Street Treatment and Resources, Inc., Fall River, Massachusetts, 02720. 
• J Subst Abuse Treat. 2016 May;64:44-6. doi: 10.1016/j.jsat.2016.01.007. Epub 2016 Feb 23.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Years of Potential Life Lost amongst Heroin Users in the Australian Treatment Outcome Study Cohort, 2001-2015

BACKGROUND:

Heroin use carries the highest burden of disease of any drug of dependence. The study aimed to determine mortality rates of the Australian Treatment Outcome Study cohort over the period 2001-2015, and the years of potential life lost (YPLL).

METHODS:

The cohort consisted of 615 heroin users. Crude mortality rates per 1000 person years (PY) and Standardised Mortality Ratios (SMR) were calculated. YPLL were calculated using two criteria: years lost prior to age 65, and years lost prior to average life expectancy.

RESULTS:

The cohort was followed for 7,790.9 PY. At 2015, 72 (11.7%) of the cohort were deceased, with a crude mortality rate of 9.2 per 1000 PYs. Neither age nor gender associated with mortality. The SMR was 10.2 (males 7.3, females 17.2), matched for age, gender and year of death. The most common mortality cause was opioid overdose (52.8%). Using the<65 years criterion, there were 1988.3 YPLL, with a mean of 27.6 (males 27.6, females 27.7). Using the average life expectancy criterion, there were 3135.1 YPLL, with a mean of 43.5 (males 41.9, females 46.3). Accidental overdose (<65yr 63.0%, average life expectancy 63.7%) and suicide (<65yr 12.8%, average life expectancy 13.3%) accounted for three quarters of YPLL where cause of death was known.

CONCLUSIONS:

YPLL associated with heroin use was a quarter of a century, or close to half a century, depending on the criteria used. Given the prominent role of overdose and suicide, the majority of these fatalities, and the associated YPLL, appear preventable.

Purchase full article at:   http://goo.gl/x8MUrf

By:  Darke S1, Marel C2, Mills KL2, Ross J2, Slade T2, Tessson M2.

• 1National Drug and Alcohol Research Centre, University of New South Wales, Australia. Electronic address: s.darke@unsw.edu.au.
• 2National Drug and Alcohol Research Centre, University of New South Wales, Australia; NHMRC Centre for Research Excellence in Mental Health and Substances Use, Australia 
• Drug Alcohol Depend. 2016 Mar 18. pii: S0376-8716(16)00152-6. doi: 10.1016/j.drugalcdep.2016.03.010. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Community Pharmacists' Experiences in Mental Illness & Addictions Care: A Qualitative Study

BACKGROUND:

Community pharmacists are accessible health care professionals who encounter people with lived experience of mental illness and addictions in daily practice. Although some existing research supports that community pharmacists' interventions result in improved patient mental health outcomes, gaps in knowledge regarding the pharmacists' experiences with service provision to this population remain. Improving knowledge regarding the pharmacists' experiences with mental illness and addictions service provision can facilitate a better understanding of their perspectives and be used to inform the development and implementation of interventions delivered by community pharmacists for people with lived experience of mental illness and addictions in communities.

METHODS:

We conducted a qualitative study using a directed content analysis and the Theoretical Domains Framework as part of our underlying theory of behaviour change and our analytic framework for theme development. The Theoretical Domains Framework facilitates understanding of behaviours of health care professionals and implementation challenges and opportunities for interventions in health care. Thematic analysis co-occurred throughout the process of the directed content analysis. We recruited community pharmacists, with experience dispensing psychotropics, at a minimum, through multiple mechanisms (e.g., professional associations) in a convenience sampling approach. Potential participants were offered the option of focus groups or interviews.

RESULTS:

Data were collected from one focus group and two interviews involving six pharmacists. Theoretical Domains Framework coding was primarily weighted in two domains: social/professional role and identity and environmental context and resources. We identified five main themes in the experiences of pharmacists in mental illness and addictions care: competing interests, demands, and time; relationships, rapport, and trust; stigma; collaboration and triage; and role expectations and clarity.

CONCLUSIONS:

Pharmacists are not practicing to their full scope of practice in mental illness and addictions care for several reasons including limitations within the work environment and lack of structures and processes in place to be fully engaged as health care professionals. More research and policy work are needed to examine better integration of pharmacists as members of the mental health care team in communities.

Below:  The Behaviour Change Wheel [47]. From Michie et al. [47]

Full article at:   http://goo.gl/X1l4Xh

By:  Murphy AL1, Phelan H2, Haslam S3, Martin-Misener R4, Kutcher SP5, Gardner DM6.

• 1College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada. andrea.murphy@dal.ca.
• 2College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada. heather.phelan@dal.ca.
• 3College of Pharmacy, Dalhousie University, 5968 College St., PO Box 15000, Halifax, NS, B3H 4R2, Canada. scott.haslam@dal.ca.
• 4School of Nursing, Dalhousie University, 5869 University Ave., PO Box 15000, Halifax, NS, B3H 4R2, Canada. ruth.martin-misener@dal.ca.
• 5Sun Life Financial Chair in Adolescent Mental Health, Dalhousie University/IWK Health Centre, 5850 University Ave., PO Box 9700, Halifax, NS, B3K 6R8, Canada. Stanley.kutcher@iwk.nshealth.ca.
• 6Department of Psychiatry, Dalhousie University, QEII HSC, AJLB 7517, 5909 Veterans' Memorial Lane, Halifax, NS, B3H 2E2, Canada. david.gardner@dal.ca.
• Subst Abuse Treat Prev Policy. 2016 Jan 28;11(1):6. doi: 10.1186/s13011-016-0050-9. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Factors Associated with Inability to Access Addiction Treatment among People Who Inject Drugs in Vancouver, Canada

BACKGROUND:

Addiction treatment is an effective strategy used to reduce drug-related harm. In the wake of recent developments in novel addiction treatment modalities, we conducted a longitudinal data analysis to examine factors associated with inability to access addiction treatment among a prospective cohort of persons who inject drugs (PWID).

METHODS:

Data were derived from two prospective cohorts of PWID in Vancouver, Canada, between December 2005 and November 2013. Using multivariate generalized estimating equations, we examined factors associated with reporting an inability to access addiction treatment.

RESULTS:

In total, 1142 PWID who had not accessed any addiction treatment during the six months prior to interview were eligible for this study, including 364 women (31.9 %). Overall, 188 (16.5 %) reported having sought but were ultimately unsuccessful in accessing addiction treatment at least once during the study period. In multivariate analysis, factors independently and positively associated with reporting inability to access addiction treatment included: binge drug use (Adjusted Odds Ratio [AOR] = 1.65), being a victim of violence (AOR = 1.77), homelessness (AOR = 1.99), and having ever accessed addiction treatment (AOR = 2.33); while length of time injecting was negatively and independently associated (AOR = 0.98) (all p < 0.05).

CONCLUSIONS:

These findings suggest that sub-populations of PWID were more likely to report experiencing difficulty accessing addiction treatment, including those who may be entrenched in severe drug addiction and vulnerable to violence. It is imperative that additional resources go into ensuring treatment options are readily available when requested for these target populations.

Reasons for being unable to access addition treatment among PWID in Vancouver, Canada (n = 250)

Reasons	Number of reports	% of reports
Waiting list	146	58.4
Don’t take couples	20	8.0
Turned down by program	19	7.6
Personal reasons/issues	13	5.2
Communication issues with the program	11	4.4
Behaviour problems	9	3.6
Missed appointments	9	3.6
Program is full	8	3.2
Don’t know of any program	7	2.8
Don’t have type of program I want or need	7	2.8
Can’t afford the fees	7	2.8
Failed too many times	2	0.8
No treatment program nearby	1	0.4
Methadone restrictions within the program	1	0.4
Other (in jail, no pets policy, medical issues, too many rules)	39	15.6

PWID people who inject drugs

Full article at:   http://goo.gl/7FjrLZ

By:  Prangnell A1, Daly-Grafstein B2, Dong H3, Nolan S4,5, Milloy MJ6,7, Wood E8,9, Kerr T10,11, Hayashi K12,13.

• 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. aprangnell@cfenet.ubc.ca.
• 2Human Biology Program, University of Toronto, Wetmore Hall, Room 105, 300 Huron Street, Toronto, ON, M5S 3J6, Canada. bendgrafstein@gmail.com.
• 3British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. hdong@cfenet.ubc.ca.
• 4British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. seonaidn@gmail.com.
• 5Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. seonaidn@gmail.com.
• 6British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.
• 7Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.
• 8British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-ew@cfenet.ubc.ca.
• 9Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-ew@cfenet.ubc.ca.
• 10British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
• 11Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-tk@cfenet.ubc.ca.
• 12British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. khayashi@cfenet.ubc.ca.
• 13Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. khayashi@cfenet.ubc.ca.
• Subst Abuse Treat Prev Policy. 2016 Feb 25;11(1):9. doi: 10.1186/s13011-016-0053-6. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Veterans' Service Utilization Patterns After Alcohol and Opioid Detoxification in VHA Care

OBJECTIVE:

This study aimed to examine detoxification-related service utilization in the Veterans Health Administration (VHA).

METHODS:

VHA data for 266,908 patients were used to examine rates and predictors of receiving detoxification, attending post-detoxification appointments, and entering specialty treatment. Multilevel, mixed-effects logistic regressions were used to examine associations between patient and facility characteristics and service utilization.

RESULTS:

Nationally, 8.0% of VHA patients with alcohol or opiate dependence received detoxification in fiscal year 2013 (facility range=.1%-20.4%); 43.1% of detoxified patients received follow-up (11.1%-76.4%), and 49.9% entered specialty treatment (13.0%-77.2%). In adjusted analyses, detoxification was more likely among male, younger, white, and homeless patients with documented alcohol or opiate disorders and comorbid general medical conditions but without previous addiction treatment. Detoxification was also more likely in facilities with fewer vacant addiction therapist positions. Follow-up and specialty treatments were more likely among younger, healthier homeless patients with previous addiction treatment and a documented alcohol use disorder.

CONCLUSIONS:

Detoxification-related service utilization was highly variable across the VHA. Interventions are needed to optimize use.

Purchase full article at:   http://goo.gl/Ygqj5c

By:  Timko C1, Gupta S1, Schultz N1, Harris AH1.

• 1The authors are with Health Services Research and Development (HSR&D), U.S. Department of Veterans Affairs, Menlo Park, California (e-mail: christine.timko@va.gov ).
• Psychiatr Serv. 2016 Jan 14:appips201400579. 

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Inability to Access Addiction Treatment Predicts Injection Initiation among Street-Involved Youth in a Canadian Setting

Background

Preventing injection drug use among vulnerable youth is critical for reducing serious drug-related harms. Addiction treatment is one evidence-based intervention to decrease problematic substance use; however, youth frequently report being unable to access treatment services and the impact of this on drug use trajectories remains largely unexplored. This study examines the relationship between being unable to access addiction treatment and injection initiation among street-involved youth.

Methods

Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth aged 14–26 who use illicit drugs, from September 2005 to May 2014. An extended Cox model with time-dependent variables was used to identify factors independently associated with injection initiation.

Results

Among 462 participants who were injection naïve at baseline, 97 (21 %) initiated injection drug use over study follow-up and 129 (28 %) reported trying but being unable to access addiction treatment in the previous 6 months at some point during the study period. The most frequently reported reason for being unable to access treatment was being put on a wait list. In a multivariable Cox regression analysis, being unable to access addiction treatment remained independently associated with a more rapid rate of injection initiation (Adjusted Hazard Ratio =2.02; 95 % Confidence Interval: 1.12–3.62), after adjusting for potential confounders.

Conclusion

Inability to access addiction treatment was common among our sample and associated with injection initiation. Findings highlight the need for easily accessible, evidence-based addiction treatment for high-risk youth as a means to prevent injection initiation and subsequent serious drug-related harms.

Full article at:   http://goo.gl/JGP3DX

By:  Kora DeBeck, Thomas Kerr, Seonaid Nolan, Huiru Dong, Julio Montaner, and Evan Wood

British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada

School of Public Policy, Simon Fraser University, Vancouver, Canada

Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada

Kora DeBeck, Phone: (604) 558-6679, Email: ac.cbu.tenefc@dk-ihru.

More at:  https://twitter.com/hiv insight

And: http://twitter.com/Prison Health

Approach to Substance Use Disorders - Video

Via:  http://www.ohtn.on.ca/

Factors Associated with the Chronicity of Intimate Partner Violence Experiences among Pregnant Women in Detoxification Services

The purpose of this study was to assess factors associated with chronicity of intimate partner violence (IPV) among pregnant substance abusers. 

A total of 114 pregnant women entering an inpatient, detoxification unit voluntarily agreed to participate in a study about women’s health and well-being. Face-to-face interviews were used for data collection. A multiple linear regression assessed the relationship between background characteristics, substance use, and IPV chronicity. 

Protective factors, which were associated with reduced chronicity of IPV, included whether most recent/current intimate partner fathered pregnancy, whether the mother was currently in a relationship with most recent/current intimate partner, whether the mother received greater social support, and increasing age. 

Childhood sexual abuse was associated with increased chronicity of IPV. Results suggest important prevention, intervention, and treatment implications for this vulnerable population.

Purchase full article at:  http://goo.gl/C0XuFP

By:  Afton Jackson MPH^a* & Lisa Shannon PhD, MSW^a

• ^a Department of Sociology, Social Work, and Criminology, Morehead State University, Morehead, Kentucky, USA 

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

Treatment-Refractory Substance Use Disorder: Focus on Alcohol, Opioids & Cocaine

Substance use disorders are common, but only a small minority of patients receive adequate treatment. Although psychosocial therapies are effective, relapse is common. This review focuses on novel pharmacological and other treatments for patients with alcohol, opioid, or cocaine use disorders who do not respond to conventional treatments. 

Disulfiram, acamprosate, and the opioid antagonist naltrexone have been approved for the treatment of alcoholism. A novel, "as needed" approach is the use of the mu-opioid antagonist and partial kappa agonist nalmefene to reduce alcohol consumption. Other novel pharmacological approaches include the GABA-B receptor agonist baclofen, anticonvulsants such as topiramate and gabapentin, the partial nicotine receptor agonist varenicline, and other drugs. 

For opioid dependence, opioid agonist therapy with methadone or buprenorphine is the first-line treatment option. Other options include oral or depot naltrexone, morphine sulfate, depot or implant formulations, and heroin (diacetylmorphine) in treatment-refractory patients. 

To date, no pharmacological treatment has been approved for cocaine addiction; however, 3 potential pharmacological treatments are being studied, disulfiram, methylphenidate, and modafinil. Pharmacogenetic approaches may help to optimize treatment response in otherwise treatment-refractory patients and to identify which patients are more likely to respond to treatment, and neuromodulation techniques such as repeated transcranial magnetic stimulation and deep brain stimulation also may play a role in the treatment of substance use disorders. 

Although no magic bullet is in sight for treatment-refractory patients, some novel medications and brain stimulation techniques have the potential to enrich treatment options at least for some patients.

Purchase full article at:    http://goo.gl/VKaheg

By:  Soyka M1, Mutschler J2.

• 1Department of Psychiatry and Psychotherapy, Ludwig Maximilian University, Nussbaumstrasse 7, 80336 Munich, Germany; Privatklinik Meiringen, Postfach 612, CH - 3860 Meiringen, Switzerland. Electronic address: michael.soyka@privatklinik-meiringen.ch.
• 2Center for Addictive Disorders, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Selnaustrasse 9, 8001 Zurich, Switzerland. 

More at:  https://twitter.com/hiv_insight

And:        http://twitter.com/Prison_Health

Effectiveness of Computer-Assisted Therapy for Substance Dependence Using Breaking Free Online: Subgroup Analyses of a Heterogeneous Sample of Service Users

Substance misuse services within the United Kingdom have traditionally been oriented to opiate and crack users, and attended predominantly by male service users. Groups who do not fit this demographic, such as women or those whose primary drug of choice is neither heroin nor crack, have tended to be underrepresented in services. In addition, there can be stigma associated with traditional opiate and crack-centric services. Therefore, the computerized treatment and recovery program, Breaking Free Online (BFO), was developed to enable service users to access confidential support for dependence on a wide range of substances. BFO is delivered as computer-assisted therapy (CAT), or, where appropriate, used as self-help.

The aim of this study was to report psychometric outcomes data from 393 service users accessing online support for substance misuse via BFO.

Following initial referral to substance misuse services, all participants were supported in setting up a BFO login by a practitioner or peer mentor, and, where required, assisted as they completed an online baseline assessment battery contained within the BFO program. Following a period of engagement with BFO, all participants completed the same battery of assessments, and changes in the scores on these assessments were examined.

Significant improvements were found across the 393 service users in several areas of psychosocial functioning, including quality of life, severity of alcohol and drug dependence, depression, and anxiety. Additionally, significant improvements were found within specific subgroups of participants, including females, males, service users reporting alcohol dependence, opiate and crack dependence, and those seeking support for other substances that may be less well represented in the substance misuse sector.

Data from this study indicates that BFO is an effective clinical treatment for a wide range of individuals requiring support for substance misuse. Further work is currently underway to examine more closely the clinical effectiveness of the program.

Table 1

The main substances of dependence (N=19).

Substance		n (%)
Alcohol		210 (53.4)
Non-opiate (and opiate substitute) or crack
	Amphetamines	11 (11.0)
	Cannabis	46 (11.7)
	Cocaine	16 (4.1)
	Diazepam	7 (7.0)
	Dihydrocodeine	2 (0.5)
	Etizolam	1 (0.3)
	GBL	1 (0.3)
	Ketamine	2 (0.5)
	Khat	2 (0.5)
	Mephedrone	3 (0.8)
	Temazepam	1 (0.3)
	Tramadol	2 (0.5)
	Zopiclon	1 (0.3)
	Total	95 (24.2)
Opiate (and opiate substitute) or crack
	Buprenorphine	5 (1.3)
	Crack	12 (3.1)
	Heroin	52 (1.2)
	Methadone	18 (4.6)
	Suboxone	1 (0.3)
	Total	88 (22.4)

Full article at: http://goo.gl/qBjDbp

By: Sarah Elison, BSc (Hons), MSc, MPhil, PhD,^#1 Glyn Davies, BSc (Hons), MSc (Econ),¹ and Jonathan Ward, BA (Econ), MSc, DClinPsy¹

¹Breaking Free Online, Manchester, United Kingdom

Sarah Elison, Breaking Free Online, 274 Deansgate, Manchester, M3 4JB, United Kingdom, Phone: 44 0161 834 ext 4647, Fax: 44 0161 834 4647, Email: moc.puorgeerfgnikaerb@nosiles.

  

More at:  https://twitter.com/hiv_insight

And: http://twitter.com/Prison_Health