High Prevalence of Assisted Injection among Street-Involved Youth in a Canadian Setting

Many people who inject illicit drugs receive manual assistance when injecting, and this practice has been linked to increased risk of HIV infection and other harms. Little is known, however, about this practice among youth. 

This study uses a multivariate generalized estimating equation to identify factors associated with receiving assistance with injecting among a cohort of street-involved youth aged 14-26 in Vancouver, Canada. 

A total of 253 participants reported injecting drugs during the study period, and 49 % (n = 125) of these youth reported receiving assistance with injecting in the past 6 months. In multivariate analysis, younger age, female gender, binge drug use, heroin injecting, cocaine injecting, crystal methamphetamine injecting, and syringe sharing were positively and independently associated with assisted injection (all p < 0.05). 

These findings underscore the need for expanding substance abuse treatment alongside HIV prevention and health promotion interventions to empower youth to enact safer injection practices.

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By:  Cheng T1,2, Kerr T1,3, Small W1,2, Dong H1, Montaner J1,3, Wood E1,3, DeBeck K4,5.

• 1Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
• 2Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.
• 3Faculty of Medicine, University of British Columbia, Vancouver, Canada.
• 4Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-kd@cfenet.ubc.ca.
• 5School of Public Policy, Simon Fraser University, Burnaby, Canada. uhri-kd@cfenet.ubc.ca. 

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Pre-Treatment Drug Use Characteristics and Experiences among Patients in a Voluntary Substance Abuse Treatment Center in Malaysia

BACKGROUND:

Drug use in Malaysia remains a significant public health and social problem despite implementation of harsh punitive drug policies such as forcibly placing suspected drug users into compulsory drug detention centers (CDDCs). Following criticism over human right violations in CDDCs, Malaysia has begun to transition towards voluntary drug treatment centers known as Cure & Care (C&C) Centers. To best serve the needs of regional C&Cs, data on drug use are essential among patients accessing treatment. Using a mixed methods approach, we examined pre-treatment drug use characteristics and experiences with addiction treatment among C&C patients in Kelantan - a religiously conservative state in Northeast Malaysia with high prevalence of drug use but where limited data are available on drug use patterns.

METHODS:

A mixed methods study utilizing surveys (N = 96) and semi-structured interviews (N = 20) was conducted among a convenience sample of inpatients and outpatients at the Pengkalan Chepa C&C Center in Kelantan.

RESULTS:

Survey results showed 89.6% of participants met screening criteria for moderate to severe addiction severity. Nearly 90% reported lifetime illicit amphetamine (syabu, meth, ice, and pil kuda) use followed by alcohol (60.4%) and opioids (52.1%). Qualitative results pointed to the powerful influence of peer networks in drug initiation and relapse, and the positive effect of the C&C on drug rehabilitation.

CONCLUSIONS:

The drug use profile of the Kelantan C&C enrollees shows extensive pre-treatment amphetamine use, polysubstance use, and injection drug use including high-risk behaviors such as sharing needles, syringes and containers. Evidence points to the need for integration of social support-oriented practices and behavioral interventions into the rehabilitation of drug users in this region.

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By:  Krishnan A1, Brown SE2, Ghani M2, Khan F3, Kamarulzaman A2,4, Altice FL2,4,5.

• 1 University at Albany, State University of New York , Department of Communication , Albany , New York , USA.
• 2 Yale University School of Medicine, Department of Internal Medicine , Section of Infectious Diseases, AIDS Program , New Haven , Connecticut , USA.
• 3 Icahn School of Medicine at Mount Sinai , New York , New York , USA.
• 4 Centre of Excellence for Research in AIDS (CERiA), University of Malaya , Kuala Lumpur , Malaysia.
• 5 Yale University School of Public Health, Division of Epidemiology of Microbial Diseases , New Haven , Connecticut , USA. 

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Screening, Brief Intervention & Referral to Treatment in a Rural Ryan White Part C HIV Clinic

About 24% of people living with HIV nationally are identified as needing treatment for alcohol or illicit drug use. Screening, Brief Intervention, and Referral to Treatment (SBIRT) has evolved as a strategy to assess and intervene with substance abuse behaviors in various clinical settings. However, less is known about the processes and outcomes of using the SBIRT intervention in outpatient HIV clinics. 

This paper presents a descriptive analysis of de-identified existing SBIRT results data from an outpatient HIV clinic located in western Colorado. From 2008 to 2013, a total of 1616 SBIRT evaluations were done, which included duplicate patients because some individual patients were screened more than once in a given year. 

Over this time period, 

• 37-49% of encounters per year were notable for tobacco use, 
• 8-21% for alcohol use, 
• 6-16% for marijuana use, 
• 3-9% for amphetamine use, and 
• 0-2% for illicit opioid use. 

Unique, unduplicated patient data from 2013 revealed 40% of patients used tobacco, 16% used alcohol, and 11% used methamphetamine. Analyses highlighted that the majority of our patient population (58% in 2013) used and/or abused tobacco, alcohol, and/or illicit substances. An alarming finding was the increase in methamphetamine use over time with more than 50-fold prevalence of use in our population compared to national rates.

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By:  Graham LJ1,2, Davis AL2, Cook PF1, Weber M1.

• 1 College of Nursing , University of Colorado , Aurora , CO , USA.
• 2 St. Mary's Hospital and Medical Center , Grand Junction , CO , USA. 
• AIDS Care. 2016 Apr;28(4):508-12. doi: 10.1080/09540121.2015.1110235. Epub 2015 Nov 7.

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                                                                                  HIV-infected H9 T Cell RF

HIV Risk Behavior among Methamphetamine Users Entering Substance Abuse Treatment in Cape Town, South Africa

South Africa is experiencing a growing methamphetamine problem, and there is concern that methamphetamine use may accelerate HIV transmission. There has been little research on the HIV prevention needs of methamphetamine users receiving substance abuse treatment in South Africa. 

This study assessed the prevalence and correlates of HIV risk behaviors among 269 methamphetamine users entering substance abuse treatment in two clinics in Cape Town. The prevalence of sexual risk behaviors was high among sexually active participants: 34 % multiple partners, 26 % unprotected intercourse with a casual partner, and 24 % sex trading for money/methamphetamine. The strongest predictor of all sexual risk behaviors was concurrent other drug use. Over half had not been HIV tested in the past year, and 25 % had never been tested, although attitudes toward HIV testing were overwhelmingly positive. This population of primarily heterosexual, non-injecting methamphetamine users is a high-risk group in need of targeted HIV prevention interventions. 

Substance abuse treatment is an ideal setting in which to reach methamphetamine users for HIV services.

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By:  Meade CS1,2, Lion RR3, Cordero DM3, Watt MH3, Joska JA4, Gouse H4, Burnhams W5.

• 1Department of Psychiatry & Behavioral Sciences, Duke University School of Medicine, Duke University, Box 90519, Durham, NC, 27708, USA. christina.meade@duke.edu.
• 2Duke Global Health Institute, Durham, NC, USA. christina.meade@duke.edu.
• 3Duke Global Health Institute, Durham, NC, USA.
• 4Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
• 5City Health, City of Cape Town, Cape Town, South Africa. 
• AIDS Behav. 2016 Feb 12.

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Sexual Risk, Substance Use, Mental Health & Trauma Experiences of Gang-Involved Homeless Youth

This study examined the associations of sexual risk behaviors, substance use, mental health, and trauma with varying levels of gang involvement in a sample of Los Angeles-based homeless youths. 

Data were collected from 505 homeless youths who self-reported various health information and whether they have ever identified as or been closely affiliated with a gang member. Multivariable logistic regression assessed associations of lifetime gang involvement with risk taking behaviors and negative health outcomes. 

Results revealed seventeen percent of youths have ever identified as a gang member and 46% as gang affiliated. Both gang members and affiliates were at greater risk of many negative behaviors than non-gang involved youths. 

Gang members and affiliates were more likely to report recent methamphetamine use, cocaine use, chronic marijuana use, having sex while intoxicated, and symptoms of depression, symptoms of posttraumatic stress disorder. They were also more likely to have experienced childhood sexual abuse and witnessing family violence. Gang members were more likely to ever attempt suicide, experience recent partner violence, and report physical abuse during childhood. 

Results suggest that lifetime gang involvement is related to a trajectory of negative outcomes and amplified risk for youths experiencing homelessness. Additionally, being closely connected to a gang member appears to have just as much as an impact on risk as personally identifying as a gang member. 

Given the lack of knowledge regarding the intersection between youth homelessness and gang involvement, future research is needed to inform policies and programs that can address the specific needs of this population.

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By:  Petering R1.

• 1School of Social Work, University of Southern California, Los Angeles, CA, USA. Electronic address: petering@usc.edu.
• J Adolesc. 2016 Feb 18;48:73-81. doi: 10.1016/j.adolescence.2016.01.009. 

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Frequency of Psychiatric Disorders in Children of Opioid or Methamphetamine-Dependent Patients - Iran

BACKGROUND:

Addiction is one of the main problems of human societies, which is more common in developing countries. In addition, it causes to personal and social problems and family problem. The aim of this study was to examine the prevalence of psychiatric disorders in children 5-15 years old of opioid or methamphetamine dependence patients.

METHODS:

For this study, three groups including: (1) children of parents addicted to opium, (2) children of parents addicted to methamphetamine, and (3) control group were examined. Child symptom inventory-4 (CSI-4) questionnaires completed by non-hospitalized guardian and control group; then make interviews with the children by the Kiddie-schedule for affective disorders and schizophrenia (K-SADS). Data were analyzed by chi-square test and ANOVA.

FINDINGS:

Survey showed that the frequency of attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD), generalized anxiety disorder, obsessive-compulsive disorder, specific phobia (SP), and separation anxiety disorder in children of addicted parents were more than a non-addicted parent. However, there was no significant difference between the two groups in the frequency of conduct disorder, social phobia, and oppositional defiant disorders (ODDs).

CONCLUSION:

Parental addiction can lead to an increase in some psychiatric disorders in the children. Therefore follow-up, early diagnosis, treatment, and prevention of these disorders in children of the drug-dependent parent are necessary to reduce health costs and improve the health system.

Comparing frequency of disorders in drug-dependent and control groups based on interviews

Interview-based disorder	Drug-dependent group [n (%)]	Control group [n (%)]	P	OD
ADHD	9 (7.5)	3 (3.8)	0.03	2
Conduct disorder	2 (1.7)	1 (1.3)	0.68	1.3
MDD	4 (3.3)	1 (1.3)	0.05	2.7
ODD	4 (3.3)	3 (3.8)	0.26	0.8
Generalized anxiety disorder	11 (2.5)	0 (0.0)	0.02	1.6
SP	11 (9.2)	7 (8.8)	0.04	1
Disorder social phobia	1 (0.8)	0 (0.0)	0.48	1.6
Obsessive compulsive disorder	3 (2.5)	0 (0.0)	0.02	1.684
Separation anxiety disorder	5 (4.2)	2 (2.5)	0.04	1.696

ADHD: Attention deficit hyperactivity disorder; MDD: Major depressive disorder; ODD: Oppositional defiant disorder; SP: Specific phobia; OD: Odds ratio

Full article at:   http://goo.gl/Uxh2XG

By:  Parvaresh N1, Mazhari S2, Nazari-Noghabi M2.

• 1Associate Professor, Neurology Research Center AND Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.
• 2Associate Professor, Neuroscience Research Center, Institute of Neuropsychopharmacology, Department of Psychiatry, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran.

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The Profile of Psychiatric Symptoms Exacerbated by Methamphetamine Use

HIGHLIGHTS

• Methamphetamine use was associated with a dose-related exacerbation of positive psychotic, affective and psychomotor symptoms.
• We found evidence of a latent symptom profile, comprised of positive psychotic and affective symptoms, that aligned with a diagnosis of substance-induced psychosis.
• Methamphetamine use did not significantly increase the severity of negative symptoms of schizophrenia.

BACKGROUND:

Methamphetamine use can produce symptoms almost indistinguishable from schizophrenia. Distinguishing between the two conditions has been hampered by the lack of a validated symptom profile for methamphetamine-induced psychiatric symptoms. We use data from a longitudinal cohort study to examine the profile of psychiatric symptoms that are acutely exacerbated by methamphetamine use.

METHODS:

164 methamphetamine users, who did not meet DSM-IV criteria for a lifetime primary psychotic disorder, were followed monthly for one year to assess the relationship between days of methamphetamine use and symptom severity on the 24-item Brief Psychiatric Rating Scale. Exacerbation of psychiatric symptoms with methamphetamine use was quantified using random coefficient models. The dimensions of symptom exacerbation were examined using principal axis factoring and a latent profile analysis.

RESULTS:

Symptoms exacerbated by methamphetamine loaded on three factors: positive psychotic symptoms (suspiciousness, unusual thought content, hallucinations, bizarre behavior); affective symptoms (depression, suicidality, guilt, hostility, somatic concern, self-neglect); and psychomotor symptoms (tension, excitement, distractibility, motor hyperactivity). Methamphetamine use did not significantly increase negative symptoms. Vulnerability to positive psychotic and affective symptom exacerbation was shared by 28% of participants, and this vulnerability aligned with a past year DSM-IV diagnosis of substance-induced psychosis (38% vs. 22%, χ²_(df1)=3.66, p=0.056).

CONCLUSION:

Methamphetamine use produced a symptom profile comprised of positive psychotic and affective symptoms, which aligned with a diagnosis of substance-induced psychosis, with no evidence of a negative syndrome.

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By:  McKetin R1, Dawe S2, Burns RA3, Hides L4, Kavanagh DJ4, Teesson M5, McD Young R4, Voce A3, Saunders JB6.

• 1National Drug Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia; National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australia. Electronic address: rebecca.mcketin@curtin.edu.au.
• 2School of Applied Psychology ​and Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
• 3Centre for Research on Ageing, Health and Wellbeing, Research School of Population Health, Australian National University, Canberra, Australia.
• 4Centre for Youth Substance Abuse Research, School of Psychology and Counselling, and Institute of Health & Biomedical Innovation, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
• 5National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
• 6Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia; Disciplines of Psychiatry and Addiction Medicine, Faculty of Medicine, University of Sydney, New South Wales, Australia. 
• Drug Alcohol Depend. 2016 Jan 30. pii: S0376-8716(16)00046-6. doi: 10.1016/j.drugalcdep.2016.01.018

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Methamphetamine Use Is Associated with High Levels of Depressive Symptoms in Adolescents & Young Adults in Rural Chiang Mai Province, Thailand

BACKGROUND:

High levels of depressive symptoms often occur among individuals that use or that are dependent on methamphetamine (MA). Thailand is currently experiencing an epidemic of MA use among youth. Understanding the nature of the relationship between depressive symptoms and MA use and identifying those most at risk can further understanding of prevention and treatment options for youth who use MA and present with depressive symptoms.

METHODS:

In 2011, we conducted a cross sectional epidemiologic study that examined associations between MA use and high levels of depressive symptoms among adolescents and young adults aged 14-29 living in Chiang Mai province, Thailand. A combination of cluster and systematic sampling was conducted to obtain a study sample of participants actively recruited in Chiang Mai province. Depressive symptoms were measured using a Thai translation of the Centers for Epidemiologic Studies Depression scale (CES-D). The independent variables measured reported lifetime and recent MA use within the past 3 months. Multivariate logistic regression models were used to assess associations between MA use and high levels of depressive symptoms.

RESULTS:

Approximately 19 % (n = 394) of the sample reported ever having consumed MA and 31 % (n = 124) of lifetime users reported recent MA use within the past 3 months. Recent MA use was associated with high levels of depressive symptoms (aPOR recent use: 2.60, 95 % CI: 1.20, 5.63).

CONCLUSIONS:

This is one of the first studies to examine the association between MA use and high levels of depressive symptoms in a general Thai population. The odds of having high levels of depressive symptoms was significantly greater among recent MA users compared to non-users. These findings support the need for policies, programs and interventions to prevent and treat depressive symptoms presenting among MA using Thai adolescents and young adults in rural Chiang Mai province, Thailand to aid in cessation of MA use. Furthermore, additional research is needed to investigate treatment options for adolescents and young adults in Thailand that use MA and present with high levels of depressive symptoms

Full article at:   http://goo.gl/OC9Y3z

By:  DiMiceli LE1, Sherman SG2, Aramrattana A3, Sirirojn B4, Celentano DD5.

• 1Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. ldimice1@jhu.edu.
• 2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. ssherman@jhsph.edu.
• 3Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. apinun@mail.med.cmu.ac.th.
• 4Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand. bangorn.s@cmu.ac.th.
• 5Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA. dcelent1@jhu.edu. 
• BMC Public Health. 2016 Feb 19;16(1):168. doi: 10.1186/s12889-016-2851-1.

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Recreational Drug Use and Related Social Factors among HIV-Positive Men in Japan

This study aims to determine the relationship between recreational drug use in HIV-positive males in the past year and socio-economic factors and/or social support networks in Japan. 

A national online survey in a cross-sectional study was conducted by HIV Futures Japan project from July 2013 to February 2014. Of the 1095 HIV-positive individuals who responded, 913 responses were determined to be valid; responses from the 875 males were analysed. A total of 282 participants used addictive drugs (32.2%) in past year. 

New psychoactive substances were used by 121 participants (13.8%), methamphetamine or amphetamine by 47 (5.4%), air dusters/sprays/gas by 31 (3.5%), 5-methoxy-N,N-diisopropyltryptamine (5MeO-DIPT) by 16 (1.8%) and cannabis (1.0%) by 9. 

Multiple logistic regression analysis was performed with the use of alkyl nitrites, addictive drugs, air dusters and thinners, which are low illegality, as dependent variables. We found that the odds ratio (95% confidence interval) for use among participants with full-time and temp/contracted/part-time employees compared to management/administration professions were 2.59 (0.99-6.77) and 2.61 (0.91-7.51). 

Also, a correlation was observed between alkyl nitrites and new psychoactive substances and usage rates in people engaged in few HIV-positive networks. It is necessary to develop targeted policies for drug use prevention and user support among HIV-positive men and to support and provide care for drug users who are isolated or have a narrow HIV/AIDS support network.

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By:  Togari T1, Inoue Y1, Takaku Y2, Abe S3, Hosokawa R4, Itagaki T5, Yoshizawa S6, Oki S7, Katakura N8, Yamauchi A9, Wakabayashi C10, Yajima T3,11.

• 1 Faculty of Liberal Arts , the Open University of Japan , Chiba , Japan.
• 2 Japan Network of People Living with HIV/AIDS , Tokyo , Japan.
• 3 Division of Health Management , TIS Inc ., Tokyo , Japan.
• 4 School of Nursing , Nagoya City University , Nagoya , Japan.
• 5 Accelight Inc ., Tokyo , Japan.
• 6 ANGEL LIFE NAGOYA , Nagoya , Japan.
• 7 Faculty of Nursing , Kyorin University , Mitaka , Japan.
• 8 Kobe City College of Nursing , Kobe , Japan.
• 9 School of Nursing , Tokyo Medical University , Tokyo , Japan.
• 10 Department of Health Sciences , Saitama Prefectural University , Koshigaya , Japan.
• 11 PLACE TOKYO , Tokyo , Japan.
• AIDS Care. 2016 Feb 17:1-9. 

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