Impulsiveness, and trait displaced aggression among drug using female sex traders

HIGHLIGHTS

• Women who traded sex for both drugs and money used crack, powder cocaine, and alcohol more.
• Women trading sex for both were higher on Impulsiveness Scales.
• Women trading for drugs only injected more and were higher on Displaced Aggression.
• Women trading for money only used marijuana more and more likely to use before sex.

OBJECTIVE:

This study compared women who sex trade for drugs, money, or both compared to neither (did not sex trade), and introduced the concept of trait displaced aggression to the literature on sex trading.

METHODS:

Female participants (n=1055) were recruited from a low-income area of southern California. Measures included: the Risk Behavior Assessment (RBA), Barratt Impulsivity Scale (BIS), Eysenck Impulsiveness Scale (EIS), and the Displaced Aggression Questionnaire (DAQ).

RESULTS:

Women who traded sex for both drugs and money used crack cocaine, powder cocaine, and alcohol significantly more, scored higher on the BIS, and the EIS, and were significantly older. Those who only sex traded for drugs used more amphetamine, heroin, and injected drugs more days. They were also higher on the DAQ and all of the DAQ subscales. Those who traded for money only used marijuana more and were more likely to use marijuana before sex.

CONCLUSIONS:

This study may help address specific issues unique to those who sex trade for different commodities in that the drugs used are different and the underlying personality characteristics are different.

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By:  Clingan SE1, Fisher DG2, Pedersen WC1, Reynolds GL3, Xandre P4.

• 1Psychology Department, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA.
• 2Psychology Department, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA. Electronic address: dennis.fisher@csulb.edu.
• 3Health Care Administration Department, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA.
• 4School of Nursing, California State University, Long Beach, 1250 Bellflower Boulevard, Long Beach, CA 90840, USA.
• Addict Behav. 2016 Apr 6;60:24-31. doi: 10.1016/j.addbeh.2016.03.027. 

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Stigma and Prejudice: The Experience of Crack Users

Objective

To evaluate the stigma and prejudice experienced by crack users in their social context.

Method

A qualitative study developed through the Fourth Generation Evaluation, conducted with four interest groups (ten users, eleven families, eight employees, and seven managers), components of the mental health care network. For data collection, we used observation and individual interview. The analysis was performed through the constant comparative method.

Results

Crack users suffer prejudice and are stigmatized as those who do not fit in the systems established by society (without family links, formal employment and dwelling), and are thus excluded. They exhibit undisciplined behavior and, therefore, are discriminated, marginalized and considered as criminals, losing their uniqueness and living in vulnerable situations.

Conclusion

The evaluation process emphasized the need to demystify the social imaginary that demonizes the chemically dependent, being thus important to develop public policies with actions focused on health, prevention, information and combat to stigma...

The capitalist society establishes the licit and illicit consumption of goods and products. In relation to crack, the user frequently consumes it in public spaces, occupying these places. Most people believes in the social imaginary that these people must be removed from the street, in order to "clean" these spaces - an urban cleaning(P1).

Therefore, it is necessary to construct a society that does not moralize life situations or the problems faced by citizens, because these factors influence the right of using public spaces that belong to everyone.

Concerning the issue of crack and drug addiction, before moving, preventing access and hiding, society must demystify the idea that the user is someone incapable, dangerous and without conditions. We need to disseminate information and deal with this problem as a health issue. We also must include the economic, educational and social assistance sector, in addition to policies, proposing the right to health care, access to public spaces and, especially, to support healthcare institutions that are prepared to assist this kind of user. To deal with drugs we need to combat prejudice and stigma and, thereby, health assistance is oriented by the production of social life.

It is possible to affirm that prejudice and stigma are very similar social processes that can result in discrimination, involving categorization and labeling, stereotyping and social rejection⁽ 12 ⁾...

Full article at:   http://goo.gl/TSJBs7

By:  Nathália Duarte Bard, 1 Beatriz Antunes, 2 Cristine Moraes Roos, 3 Agnes Olschowsky, 4 and Leandro Barbosa de Pinho5

¹Undergraduate student in Nursing, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil. Scholarship holder from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Brazil

²Master's student, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

³PhD

⁴PhD, Full Professor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

⁵PhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

Corresponding Author: Nathália Duarte Bard Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manuel, 963 Bairro: Rio Branco CEP: 90620-110, Porto Alegre, RS

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Public Opinions About Supervised Smoking Facilities for Crack Cocaine & Other Stimulants

BACKGROUND:

The purpose of this study was to estimate awareness and opinions about supervised smoking facilities (SSFs) for smoking crack cocaine and other stimulants and make comparisons with awareness and opinions about supervised injection facilities (SIFs) in Ontario, Canada.

METHODS:

We used data from a 2009 telephone survey of a representative adult sample. The survey asked about awareness of, and level of support for, the implementation of SSFs and SIFs. Data were analysed using statistical models for complex survey data, which account for stratified sampling and incorporate sampling weights.

RESULTS:

A total of 1035 participated in the survey. Significantly fewer had knowledge about SSFs (17.9 %) than about SIFs (57.6 %). Fewer strongly agreed with implementation of SSFs (19.6 %) than SIFs (28.3 %). Just over half (51.1 %) of participants somewhat agreed or disagreed, 15.7 % strongly agreed, and 10.6 % strongly disagreed with implementing both SSFs and SIFs.

CONCLUSIONS:

Members of the public in Ontario had little knowledge of SSFs compared to SIFs. Recent federal government changes in Canada may provide the leadership environment necessary to ensure that innovative, evidence-based harm reduction programs such as SSFs are developed and implemented.

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

By:  Strike C1, Rotondi NK2, Watson TM3, Kolla G4, Bayoumi AM5,6,7,8.

• 1Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada. carol.strike@utoronto.ca.
• 2Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada. nooshin.rotondi@gmail.com.
• 3Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada. tara.watson@utoronto.ca.
• 4Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Canada. gillian.kolla@utoronto.ca.
• 5Centre for Research on Innercity Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, Canada. ahmed.bayoumi@utoronto.ca.
• 6Department of Medicine, University of Toronto, 1 King's College Circle, Toronto, Canada. ahmed.bayoumi@utoronto.ca.
• 7Institute of Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, Canada. ahmed.bayoumi@utoronto.ca.
• 8Division of General Internal Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, Canada. ahmed.bayoumi@utoronto.ca. 
• Subst Abuse Treat Prev Policy. 2016 Feb 9;11(1):8. doi: 10.1186/s13011-016-0052-7.

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Characteristics of Clients Using a Community-Based Drug Treatment Service (‘CAPS-AD’) in Brazil: An Exploratory Study

Highlights

• ‘CAPS-AD’ is a novel vehicle of community-based treatment for alcohol and drugs in Brazil.
• We assessed a ‘snapshot sample’ of CAPS-AD clients in Brasilia (capital of Brazil).
• Most clients were male, middle-aged, unemployed, with alcohol or crack-cocaine problems.
• Half engaged in their first-ever treatment episode, suggesting effective reach by the CAPS-AD.
• Concerns about care structures, logistics and staff attitudes may compromise client retention.

Abstract

Background

Substance use is common in Brazil. In order to improve availability of substance misuse care services, over 400 Psycho-Social Care Centres for Alcohol and Drugs (CAPS-AD) – providing community-based care – have been established following mental health care reform (2001). Information on CAPS-AD clients and outcomes is limited. The present study examined select characteristics of local CAPS-AD clients.

Methods

N = 143 adult CAPS-AD clients in Ceilândia (suburb of Brasília, Federal District) participated in a 1-week ‘snapshot’ assessment of service users (February 2015). Following consent, descriptive data were collected by a brief, anonymous interviewer-administered questionnaire that included socio-demographic, drug use, treatment history and needs/barriers information.

Results

Participants were predominantly male; middle-aged; unemployed; married; with middle-school education; primary problem drugs indicated were alcohol and cocaine/crack; half had prior treatment histories and indicated that treatment was externally motivated; 60% reported ways to improve treatment and possible reasons for treatment discontinuation; in multi-variate analyses, the latter was associated with employment and education status (both p < .05).

Conclusion

CAPS-AD services appear to have increased low-barrier substance misuse treatment availability in Brazil, as well as attract individuals new to the treatment system. Various potential barriers to continuing in treatment should be addressed and more research on CAPS-AD clients and outcomes is needed.

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By:  Andrea Donatti Gallassi, Eduardo Yoshio Nakano, Gabriela Arantes Wagner, Maria de Nazareth Rodrigues Malcher de Oliveira Silva, Benedikt Fischer

Affiliations

Center of Drugs and Associated Vulnerabilities, Faculty of Ceilândia, University of Brasilia, Brazil

Science and Health Technology Program, Faculty of Ceilândia, University of Brasilia, Brazil

Correspondence

Corresponding author at: Center of Drugs and Associated Vulnerabilities, University of Brasília (UNB), Faculty of Ceilândia, Centro Metropolitano 1, Conjunto A – Ceilândia Sul Zip 72220-900, Brasília DF, Brazil. Tel.: +55 6133770615.

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Crack Pipe Sharing among Street-Involved Youth in a Canadian Setting

INTRODUCTION AND AIMS:

Crack pipe sharing is a risky practice that has been associated with the transmission of hepatitis C and other harms. While previous research has exclusively focused on this phenomenon among adults, this study examines crack pipe sharing among street-involved youth.

DESIGN AND METHODS:

From May 2006 to May 2012, data were collected from the At-Risk Youth Study, a cohort of street-involved youth aged 14-26 in Vancouver, Canada. Survey data from active crack smokers were analysed using generalised estimating equations logistic regression.

RESULTS:

Over the study period, 567 youth reported smoking crack cocaine and contributed 1288 observations, among which 961 (75%) included a report of crack pipe sharing. In multivariate analysis, factors that were associated with crack pipe sharing included difficulty accessing crack pipes; homelessness; regular employment; daily non-injection crystal methamphetamine use; daily crack smoking; encounters with the police; and reporting unprotected sex.

DISCUSSION AND CONCLUSIONS:

The prevalence of crack pipe sharing was high among our sample and independently associated with structural factors including difficulty accessing crack pipes and homelessness. Crack pipe sharing was also associated with high-intensity drug use and a number of other markers of risk and vulnerability. Collectively, these findings highlight opportunities for health services to better engage with this vulnerable group and reduce this risky behaviour.

Purchase full article at:   http://goo.gl/EV40JS

By:  Cheng T1, Wood E, Nguyen P, Montaner J, Kerr T, DeBeck K.

• 1British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada. 
• Drug Alcohol Rev. 2015 May;34(3):259-66. doi: 10.1111/dar.12180. Epub 2014 Jul 25.

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Prevalence & Factors Associated with Sex Trading in the Year Prior to Entering Treatment for Drug Misuse in England

BACKGROUND:

This study estimates the past year prevalence of and factors associated with sex trading (offering sex for money, drugs or something else) among 1796 men and women presenting to 342 drug misuse treatment agencies in England, and identifies service development and delivery implications.

METHODS:

Secondary analysis of baseline data from a prospective cohort was conducted. Short Form-12 measured mental and physical wellbeing, psychiatric diagnoses were self-reported and the circumstances, motivation and readiness tool assessed readiness for/pressure to enter treatment. Logistic regression models determined associations with sex trading separately by sex. Inverse probability population weights were calculated, utilising demographics from the National Drug Treatment Monitoring System and agency specific data collection windows.

RESULTS:

The estimated prevalence rate of sex trading in the past 12 months was 5.1% (15.0% for women and 2.1% for men). For women, adjusted models identified crack use, previous treatment and greater readiness for treatment  as independently associated with sex trading. For men, lower mental wellbeing was independently associated and marginal effects were identified for syringe sharing and unprotected sex.

CONCLUSIONS:

Sex trading among drug misusers is associated with additional health risks and specific treatment needs. Given the scale of the problem it is important that treatment providers have the competencies to adequately address the issue and provide accessible and appropriate services.

Purchase full article at:   http://goo.gl/4LJKF1

By:  Gilchrist G1, Singleton N2, Donmall M3, Jones A4.

• 1King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom. Electronic address: gail.gilchrist@kcl.ac.uk.
• 2King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, 4 Windsor Walk, London SE5 8BB, United Kingdom. Electronic address: Nicola.Singleton@kcl.ac.uk.
• 3National Drug Evidence Centre, Institute of Population Health, University of Manchester, Ellen Wilkinson Building, 4th Floor, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: M.Donmall@manchester.ac.uk.
• 4National Drug Evidence Centre, Institute of Population Health, University of Manchester, Ellen Wilkinson Building, 4th Floor, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: Andrew.Jones@manchester.ac.uk.
• Drug Alcohol Depend. 2015 Jul 1;152:116-22. doi: 10.1016/j.drugalcdep.2015.04.017. Epub 2015 Apr 30. 

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Sexual Health Risks & Health-Seeking Behaviours among Substance-Misusing Women

AIMS:

To report on a survey of sexual health service needs among substance-misusing women attending a substance misuse service.

BACKGROUND:

Substance-misusing women carry a disproportionate burden of sexual ill health, yet the range and frequency of their sexual health risks, morbidities and service engagement are poorly understood.

DESIGN:

A cross-sectional survey of a convenience sample of substance-misusing women attending a substance misuse service.

METHODS:

From 4 April 2010-17 September 2010, substance-misusing women in Hastings & Ore, UK, were invited to complete a paper questionnaire addressing: drug use; cervical cytology, sexually transmitted infection and HIV screening history; pregnancy history, perceived pregnancy risk and contraceptive advice and supply; sexual activity and assault. Of 91 respondents, 77 attended local drug treatment services - results comprise analysis of this sub-sample.

RESULTS:

The study sample was characterized by long-term opioid and crack cocaine use. Of 53% sexually active in the previous 4 weeks, 66% perceived they had experienced sexual intercourse that could lead to pregnancy during that time. Fifty-five per cent had been forced to have sex against their will during their lifetime. High rates of sexually transmitted infections, pregnancy termination, miscarriage and abnormal cervical cytology were reported.

CONCLUSIONS:

Findings indicate the need to recognize the breadth of elevated sexual health risks and morbidities experienced by substance-misusing women with long-term opioid/crack use, including those not identifying as intravenous drug users. Poor recall of drop-in and appointment times, reluctance to disclose substance misuse and likelihood of previous sexual assault present significant challenges to nurses, who must take a sensitive, opportunistic approach to referral and provision of sexual health interventions to substance-misusing women.

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By:   Edelman NL¹, Patel H, Glasper A, Bogen-Johnston L.

¹Centre for Health Research, University of Brighton, Falmer, UK.

J Adv Nurs. 2014 Dec;70(12):2861-70. doi: 10.1111/jan.12442. Epub 2014 May 7. 

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Measuring Current Drug Use in Female Sex Workers and Their Noncommercial Male Partners in Mexico: Concordance Between Data Collected from Surveys vs Semi-Structured Interviews

BACKGROUND:

Self-reports are commonly used to assess prevalence and frequency of drug use, but it is unclear whether qualitative methods like semi-structured interviews are as useful at obtaining such information as quantitative surveys.

OBJECTIVES:

This study compared drug use occurrence and frequency using data collected from quantitative surveys and qualitative interviews. We also examined whether combining data from both sources could result in significant increases in percentages of current users and whether the concordance between the two sets of data was associated with the type of drug use, age, gender and socioeconomic status.

METHODS:

Self- reports of recent marijuana, heroin, crack, cocaine, crystal/methamphetamine, inhalant, and tranquilizer use were collected using both methods from a cohort of Mexican female sex workers and their non-commercial male partners (n = 82).

RESULTS:

Participants were significantly less likely to report marijuana, cocaine and tranquilizer use and frequency of use during the qualitative interviews than during the quantitative surveys. Agreement on frequency of drug use was excellent for crystal/methamphetamine, heroin and inhalant use, and weak for cocaine, tranquilizers and marijuana use. Older participants exhibited significantly higher concordance than younger participants in reports of marijuana and methamphetamine use. Higher monthly income was significantly associated with higher concordance in crack use but lower concordance with marijuana use.

CONCLUSIONS:

Although use of such data can result in an underreporting of drug use, qualitative data can be quantified in certain circumstances to triangulate and confirm the results from quantitative analyses and provide a more comprehensive view of drug use.

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By:   Palinkas LA1, Bazzi AR2, Syvertsen JL3, Ulibarri MD4, Hernandez D5, Rangel MG6, Martinez G7, Strathdee SA8.

• 1 School of Social Work , University of Southern California , Los Angeles , California , USA.
• 2 Community Health Sciences , Boston University , Boston , Massachusetts , USA.
• 3 Anthropology, The Ohio State University , Columbus , Ohio , USA.
• 4 Psychiatry, University of California , San Diego, La Jolla , California , USA.
• 5 School of Medicine , University of California , Davis, Sacramento , California , USA.
• 6 El Colegio de la Frontera Norte , Tijuana , Mexico.
• 7 Federacion Mexicana de Asociaciones Privadas , Cuidad Juarez , Mexico.
• 8 Division of Global Public Health , University of California , San Diego, La Jolla , California , USA. 

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Using Peer-Referral Chains with Incentives to Promote HIV Testing and Identify Undiagnosed HIV Infections among Crack Users in San Salvador

In El Salvador, crack users are at high risk for HIV but they are not targeted by efforts to promote early HIV diagnosis. 

We evaluated the promise of peer-referral chains with incentives to increase HIV testing and identify undiagnosed HIV infections among networks of crack users in San Salvador. For 14 months, we offered HIV testing in communities with a high prevalence of crack use. For the following 14 months, we promoted chains in which crack users from these communities referred their peers to HIV testing and received a small monetary incentive. We recorded the monthly numbers of HIV testers, and their crack use, sexual risk behaviors and test results. 

After launching the referral chains, the monthly numbers of HIV testers increased significantly (Z = 6.90, p < .001) and decayed more slowly (Z = 5.93, p < .001), and the total number of crack-using testers increased nearly fourfold. Testers in the peer-referral period reported fewer HIV risk behaviors, but a similar percentage (~5 %) tested HIV positive in both periods. More women than men received an HIV-positive diagnosis throughout the study (χ²(1, N = 799) = 4.23, p = .040). 

Peer-referral chains with incentives can potentially increase HIV testing among networks of crack users while retaining a focus on high-risk individuals.

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By:   Glasman LR1, Dickson-Gomez J2, Lechuga J3, Tarima S4, Bodnar G5, de Mendoza LR6.

• 1Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N Summit Ave., Milwaukee, WI, USA. lglasman@mcw.edu.
• 2Center for AIDS Intervention Research, Medical College of Wisconsin, 2071 N Summit Ave., Milwaukee, WI, USA.
• 3Department of Psychology, University of Texas, El Paso, TX, USA.
• 4Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
• 5Departamento de Investigación, Fundación Antidrogas de El Salvador (FUNDASALVA), Santa Tecla, El Salvador.
• 6Department of Psychology, Universidad Centroamericana José Simeón Cañas, San Salvador, El Salvador. 

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'Two Pains Together': Patient Perspectives on Psychological Aspects of Chronic Pain While Living with HIV

OBJECTIVE:

Chronic pain is common in HIV-infected individuals. Understanding HIV-infected patients' chronic pain experience not just from a biological, but also from a psychological perspective, is a critical first step toward improving care for this population. Our objective was to explore HIV-infected patients' perspectives on psychological aspects of chronic pain using in-depth qualitative interviews.

METHODS:

Investigators engaged in an iterative process of independent and group coding until theme saturation was reached.

RESULTS:

Of the 25 patients with chronic pain interviewed, 20 were male, 15 were younger than age 50, and 15 were African-American. Key themes that emerged included the close relationship between mood and pain; mood and pain in the context of living with HIV; use of alcohol/drugs to self-medicate for pain; and the challenge of receiving prescription pain medications while dealing with substance use disorders.

CONCLUSIONS:

The results suggest that psychological approaches to chronic pain treatment may be well received by HIV-infected patients.

...Use of alcohol/drugs to self-medicate for pain

A minority of participants reported that pain actually led them to use alcohol or drugs, in an attempt to alleviate their suffering. One participant described how in his case alcohol worked to help him manage his pain:

I would just drink [alcohol] it until my mind – it takes your mind differently. After you’ve had a few you get a good buzz going on and you don’t think about the pain no more. 34-year-old African-American male

Another participant explained how pain actually fueled the development of his addiction to illicit drugs:

Well, [pain and drug use] go hand in hand. Because when I hurt I wanna stop hurting so… and I know that… I know what will help me stop hurting…But and that’s the problem now is I use it when I’m not hurting…. It did go hand in hand for me but now it just became a, a problem or addiction.” 45-year-old African-American male

Most participants who discussed the role of illicit substances felt that self-medication in this way is only a temporary fix. After the drug has worn off, the person is left with their original pain:

You know, you know, drugs doesn’t help because uh if you try to alleviate the pain with – with drinkin’ alcohol ‘cause you gonna just – it’s gonna be a hurtin’ drunk. 52-year-old African-American male with severe chronic pain

For the few minutes that I’m using drugs, I don’t hurt…. And I might, uh, it might last, the pain might be gone for thirty minutes, hour…. But that’s only because cocaine done numb the feeling, I guess…But it, it always comes back which caused me to keep going get more cocaine 45-year-old African-American male

One participant felt that after getting off drugs his pain was even worse:

Uh actually … when I was doin’ the drugs [crack cocaine] I – I didn’t notice the pain. But now that I’m not I do feel – feel it a little more intensely. 48-year-old African American male...

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

By:   Merlin JS¹, Walcott M², Ritchie C³, Herbey I², Kertesz SG⁴, Chamot E⁵, Saag M², Turan JM⁵.

¹Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America; Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

²Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

³Division of Geriatrics, Department of Medicine, University of California at San Francisco, San Francisco, California, United States of America; Jewish Home of San Francisco Center for Research on Aging, San Francisco, California, United States of America.

⁴Birmingham VA Medical Center, Birmingham, Alabama, United States of America; Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

⁵School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, United States of America.

  

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High-Intensity Drug Use and Health Service Access among Street-Involved Youth in a Canadian Setting

BACKGROUND/OBJECTIVES:

Addiction severity has been associated with numerous social- and health-related harms. This study sought to examine the prevalence and correlates of high-intensity drug use among street-involved youth in a Canadian setting with a focus on high-risk drug use practices and health service access.

METHODS:

Data were derived from the At-Risk Youth Study, a Vancouver-based prospective cohort of street-involved youth aged 14-26. We used generalized estimating equations to examine variables associated with high-intensity drug use, defined as daily use of crack cocaine, cocaine, heroin, or crystal methamphetamine.

RESULTS:

From September 2005 to November 2012, of 1017 youth included in the analyses, 529 (52%) reported high-intensity drug use as defined above at least once during the study period. In a multivariate analysis, older age; residing in the Downtown Eastside of Vancouver; homelessness; recent incarceration; inability to access addiction treatment; and crack pipe sharing and/or used syringe injecting, were all positively and independently associated with high-intensity drug use. The most common barrier to accessing addiction treatment reported by these youth was long waiting lists.

CONCLUSIONS:

High-intensity drug use among street-involved youth was prevalent and associated with structural and geographical disadvantages in addition to high-risk drug administration practices. Youth reporting more frequent drug use also reported barriers to accessing addiction treatment, highlighting the need to expand addiction services tailored to youth at greatest risk of harm from illicit drug use and street-involvement.

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By:   Phillips M1, Richardson L1, Wood E1, Nguyen P1, Kerr T1, DeBeck K1.

• 1a BC Centre for Excellence in HIV/AIDS , Urban Health Research Initiative , Vancouver , Canada. 

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