Explanations & Expectations: Drug Narratives among Young Marijuana Users In Treatment

This article analyses how young people enrolled in drug addiction treatment in Copenhagen, Denmark, explain their cannabis careers and how they view their possibilities for quitting drug use again. Inspired by Mead and narrative studies of health and illness, the article identifies four different drug use ‘aetiologies’ drawn upon by the interviewees. These cover childhood experiences, self-medication, the influence of friends and cannabis use as a specific lifestyle.

A central argument of the article is that these explanations not only concern the past but also point towards the future by assigning the interviewee a more or less agential position in relation to drugs. 

Further, the drug narratives are viewed as interactional achievements, related to the social context in which they were produced, namely, the institutional setting of the treatment centres. 

The article is based on 30 qualitative interviews with young people in drug addiction treatment.

...Participants’ expectations regarding the future were also related to their drug use patterns at the time of the interview, but in complex ways. For instance, some of the interviewees who said they could easily stop described an intense current use, sometimes with severe consequences for their quality of life, which made it difficult for them to explain why they continued. Also, some of the interviewees who said they were unable to stop using cannabis reported that they had not smoked it for months. There was a pattern though, tying explanations of drug use development to participants’ present smoking practice. By and large, current cannabis use was more common among interviewees drawing on the self-medication and lifestyle explanations than in the two other narrative categories. While for the former category this was because of a perceived medical ‘need’ for the drug, for the latter it was presented as a personal preference for continued smoking.

The interviewees’ explanations were not produced in a social vacuum; rather they should be seen in relation to specific contexts. First, the interview setting in itself may have influenced the drug use aetiologies depicted in the accounts. An interview is, as we stated earlier, a specific type of interaction (an ‘elicited context’, cf. Hydén ¹⁹⁹⁷: 62) where the interviewee is supposed to produce a coherent narrative. The interactional dynamic of an interview may contribute to the development of ‘dominant’ explanations. Interviewers typically respond to the statements of interviewees by accepting them, showing empathy and understanding, asking the interviewees to elaborate on certain themes (and not others), etc. – and all this may be conductive to the creation of specific causal patterns in the interviewees’ accounts. In this sense, the interviews in themselves may have contributed to the shaping, and sharpening, of certain explanations at the expense of others, explanations that we later identified as ‘dominant’.

Second, the interviewees’ explanations may be related to the treatment contexts in which the interviewees were enrolled. As mentioned in the methods section, participants were recruited from three small treatment centres (Centre A: 14 interviewees; Centre B: 12 interviewees and Centre C: four interviewees). These three centres have a lot in common: they are out-patient units working with a combination of therapeutic approaches (systems therapy, cognitive therapy and narrative therapy) and they have young people under 25 as their primary target group. But there are also differences. Centre A is more oriented towards psychiatry and more focused on using tests (ADHD-tests, intelligence tests, addiction severity tests) than the two other centres. Centre B is more narratively oriented, and at least some of the staff members are sceptical towards tests. This centre is explicitly concerned with not defining their clients as drug abusers and with reducing the stigma often associated with illicit drug use. Cannabis smoking in itself is not necessarily a problem, according to this centre, and ‘controlled’ use is just as good a treatment goal as abstinence. Centre B is also preoccupied with ‘unravelling’ the clients’ family backgrounds. Drug use is often seen as an indication that something is wrong in the families, not with the young drug user…

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

By:  Margaretha Järvinen¹ and Signe Ravn²

¹Department of Sociology, University of Copenhagen and SFI – The Danish National Centre for Social Research, Copenhagen, Denmark

²SFI – The Danish National Centre for Social Research, Copenhagen, Denmark

Address for correspondence: Margaretha Jarvinen, University of Copenhagen - Department of Sociology, Øster Farimagsgade 5, Copenhagen K 1014 K, Denmark. E-mail: kd.uk.cos@jma

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Self-Reported Changes in Drug Use Behaviors & Syringe Disposal Methods Following the Opening of a Supervised Injecting Facility in Copenhagen, Denmark

Background

In Denmark, the first standalone supervised injecting facility (SIF) opened in Copenhagen’s Vesterbro neighborhood on October 1, 2012. The purpose of this study was to assess whether use of services provided by the recently opened SIF was associated with changes in injecting behavior and syringe disposal practices among people who inject drugs (PWID). We hypothesized that risk behaviors (e.g., syringe sharing), and unsafe syringe disposal (e.g., dropping used equipment on the ground) had decreased among PWID utilizing the SIF.

Methods

Between February and August of 2013, we conducted interviews using a survey (in English and Danish) with forty-one people who reported injecting drugs at the SIF. We used descriptive statistics and McNemar’s test to examine sociodemographic characteristics of the sample, current drugs used, sites of syringe disposal before and after opening of the SIF, and perceived behavior change since using the SIF.

Results

Of the interviewed participants, 90.2% were male and the majority were younger than 40 years old (60.9%). Three-quarters (75.6%) of participants reported reductions in injection risk behaviors since the opening of the SIF, such as injecting in a less rushed manner (63.4%), fewer outdoor injections (56.1%), no longer syringe sharing (53.7%), and cleaning injecting site(s) more often (43.9%). Approximately two-thirds (65.9%) of participants did not feel that their frequency of injecting had changed; five participants (12.2%) reported a decrease in injecting frequency, and only two participants (4.9%) reported an increase in injecting frequency. Twenty-four (58.5%) individuals reported changing their syringe disposal practices since the opening of the SIF; of those, twenty-three (95.8%) reported changing from not always disposing safely to always disposing safely (McNemar’s test p-value < 0.001).

Conclusions

Our findings suggest that use of the Copenhagen SIF is associated with adoption of safer behaviors that reduce harm and promote health among PWID, as well as practices that benefit the Vesterbro neighborhood (i.e., safer syringe disposal). As a public health intervention, Copenhagen’s SIF has successfully reached PWID engaging in risk behavior. To fully characterize the impacts of this and other Danish SIFs, further research should replicate this study with a larger sample size and prospective follow-up.

Table 2

Primary locations for disposal of used syringes among a sample of people who inject drugs before and after the opening of a supervised injecting facility in Copenhagen, Denmark ( n  = 41)

Disposal mechanism/site	Before SIF opened n (%)	After SIF opened n (%)
Returned to the needle exchange (or SIF)	14 (34.1)	36 (87.8)
Put them in an outdoors sharps container	19 (46.3)	8 (19.5)
Put them in their own sharps container	11 (26.8)	6 (14.6)
Threw them in the garbage	23 (56.1)	5 (12.2)
Dropped them on the ground	5 (12.2)	0 (0.0)
Gave them to another user	2 (4.9)	0 (0.0)
Flushed them down the toilet	4 (9.8)	0 (0.0)
Other	3 (7.3)	0 (0.0)

Note: n’s do not sum to 41 and proportions do not sum to 100% because participants may have identified more than one location as primary site of used syringe disposal.

Note: all data collected between February and August, 2013.

Table 3

Perceived behavior and frequency change among a sample of people who inject drugs at a supervised injecting facility since its opening in Copenhagen, Denmark ( n  = 41)

Characteristic	n (%)
Any perceived behavior change	31 (75.6)
Less rushed/stressful	26 (63.4)
Less injecting outdoors	23 (56.1)
No longer share needles	22 (53.7)
Clean injection site more often	18 (43.9)
Easier to get vein first time	16 (39.0)
Reuse own needles less often	11 (26.8)
Use clean water more often	11 (26.8)
No longer need help injecting	6 (14.6)
Other	3 (7.3)
Perceived frequency change
No change	27 (65.9)
Decreased (inject less often)	5 (12.2)
Increased (inject more often)	2 (4.9)
Unsure	4 (9.8)

Note: n’s do not sum to 41 and proportions do not sum to 100% due to missing values or where participants endorsed more than one option.

Note: all data collected between February and August, 2013.

Full article at:   http://goo.gl/2IuC7S

By:   Elizabeth N Kinnard, Chanelle J Howe, Thomas Kerr, Vibeke Skjødt Hass, and Brandon DL Marshall

Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Box G-S-121-4 Providence, RI 02912 USA

Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912 USA

Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC V6T 1Z3 Canada

Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, 608 – 1081 Burrard Street, Vancouver, BC V6Z 1Y6 Canada

The Saxo Institute, Faculty of Humanities, University of Copenhagen, Karen Blixens Vej 4, DK-2300 Copenhagen, Denmark

Elizabeth N Kinnard, Email: ude.nworb@dranniK_htebazilE.

  

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Screening for TB by Sputum Culture in High-Risk Groups in Copenhagen, Denmark: A Novel & Promising Approach

INTRODUCTION:

Evidence on screening high-risk groups for TB by mobile X-ray in low-incidence countries is building, but knowledge on other possible screening methods is limited. In this retrospective study we report results from a community based programme screening for TB by spot sputum culture.

METHODS:

On seven occasions, from September 2012 through June 2014, we offered TB screening to all persons present at 11 locations where socially marginalised people gather in Copenhagen. Spot sputum samples from participants were examined by smear microscopy and culture. Genotype, nucleic acid amplification test and chest X-ray were done if TB was found.

RESULTS:

Among 1075 participants, we identified 36 cases of TB. Twenty-four cases (66.7%) were identified at the first screening of each participant, that is, the prevalence of TB was 2233/100 000. Thirty-five (97%) of the TB cases were culture-positive and seven (19.4%) were smear-positive. Twelve out of 21 (57.1%) cases tested were nucleic acid amplification test positive. Twenty-eight (77.8%) had chest X-ray suggestive of TB. All patients with TB started treatment, 30 (83.3%) had a successful outcome.

DISCUSSION:

Screening for TB by spot sputum culture is possible and a promising alternative to mobile X-ray in a community based screening programme. 22.2% did not have chest X-ray suggestive of TB and would not have been identified using mobile X-ray. Most of the TB cases were smear-negative, suggesting that they were identified at an early, less infectious stage, which is essential in order to prevent transmission and gain infection control.

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

By:   Jensen SG1, Olsen NW1, Seersholm N1, Lillebaek T2, Wilcke T1, Pedersen MK2, Kok-Jensen A2.

• 1Department of Respiratory Medicine, Gentofte Hospital, Hellerup, Copenhagen, Denmark.
• 2International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark. 

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Alcohol Consumption & Binge Drinking In Early Pregnancy. A Cross-Sectional Study with Data from the Copenhagen Pregnancy Cohort

Background

Since 2007 the Danish Health and Medicines Authority has advised total alcohol abstinence from the time of trying to conceive and throughout pregnancy. The prevalence of binge drinking among pregnant Danish women has nevertheless been reported to be up to 48 % during early pregnancy. Since the introduction of the recommendation of total abstinence, no studies have examined pre-pregnancy lifestyle and reproductive risk factors associated with this behaviour in a Danish context. The aims of this study were therefore to describe the prevalence of weekly alcohol consumption and binge drinking in early pregnancy among women living in the capital of Denmark. Secondly to identify pre-pregnancy lifestyle and reproductive risk factors associated with binge drinking during early pregnancy.

Methods

Data were collected from September 2012 to August 2013 at the Department of Obstetrics, Rigshospitalet, Copenhagen, Denmark. Self-reported information on each woman’s socio-demographic characteristics, medical history, and lifestyle factors including alcohol habits was obtained from an electronic questionnaire filled out as part of the individual medical record. Descriptive analysis was conducted and multivariate logistic regression analysis was used to assess the potential associated risk factors (adjusted odds ratio (aOR)).

Results

Questionnaires from 3,238 women were included. A majority of 70 %, reported weekly alcohol consumption before pregnancy. The prevalence decreased to 3 % during early pregnancy. The overall proportion of women reporting binge drinking during early pregnancy was 35 % (n = 1,134). The following independent risk factors for binge drinking in early pregnancy were identified: lower degree of planned pregnancy, smoking and alcohol habits before pregnancy ((1 unit/weekly aOR 4.48, CI: 3.14 - 6.40), (2–7 units aOR 10.23, CI: 7.44-14.06), (≥8 units aOR 33.18, CI: 19.53-56.36)). Multiparity and the use of assisted reproductive technology were associated with lower odds of binge drinking in early pregnancy.

Conclusion

The prevalence of weekly alcohol consumption decreased considerably during early pregnancy compared with pre-pregnancy levels. Nevertheless one third of the pregnant women engaged in binge drinking. Identification of risk factors for this behaviour renders it possible not only to design prevention strategies, but also to target those most at risk.

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

By:  

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Syphilis and HIV Co-Infection - Denmark

The studies included in this PhD thesis examined the interactions of syphilis, which is caused by Treponema pallidum, and HIV. Syphilis reemerged worldwide in the late 1990s and hereafter increasing rates of early syphilis were also reported in Denmark. 

The proportion of patients with concurrent HIV has been substantial, ranging from one third to almost two thirds of patients diagnosed with syphilis some years. Given that syphilis facilitates transmission and acquisition of HIV the two sexually transmitted diseases are of major public health concern. Further, syphilis has a negative impact on HIV infection, resulting in increasing viral loads and decreasing CD4 cell counts during syphilis infection. 

Likewise, HIV has an impact on the clinical course of syphilis; patients with concurrent HIV are thought to be at increased risk of neurological complications and treatment failure. Almost ten per cent of Danish men with syphilis acquired HIV infection within five years after they were diagnosed with syphilis during an 11-year study period. Interestingly, the risk of HIV declined during the later part of the period. 

Moreover, HIV-infected men had a substantial increased risk of re-infection with syphilis compared to HIV-uninfected men. As one third of the HIV-infected patients had viral loads >1,000 copies/ml, our conclusion supported the initiation of cART in more HIV-infected MSM to reduce HIV transmission. 

During a five-year study period, including the majority of HIV-infected patients from the Copenhagen area, we observed that syphilis was diagnosed in the primary, secondary, early and late latent stage. These patients were treated with either doxycycline or penicillin and the rate of treatment failure was similar in the two groups, indicating that doxycycline can be used as a treatment alternative - at least in an HIV-infected population. During a four-year study period, the T. pallidum strain type distribution was investigated among patients diagnosed by PCR testing of material from genital lesions. In total, 22 strain types were identified. HIV-infected patients were diagnosed with nine different strains types and a difference by HIV status was not observed indicating that HIV-infected patients did not belong to separate sexual networks. 

In conclusion, concurrent HIV remains common in patients diagnosed with syphilis in Denmark, both in those diagnosed by serological testing and PCR testing. Although the rate of syphilis has stabilized in recent years, a spread to low-risk groups is of concern, especially due to the complex symptomatology of syphilis. However, given the efficient treatment options and the targeted screening of pregnant women and persons at higher risk of syphilis, control of the infection seems within reach. Avoiding new HIV infections is the major challenge and here cART may play a prominent role.

Full (PDF) article at:  http://goo.gl/ixrJbZ

By:  Kirsten Salado-Rasmussen

Correspondence: Department of Infectious Diseases, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen. Denmark E-mail: ksalado@hotmail.com

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