Modeling the initiation of others into injection drug use, using data from 2,500 injectors surveyed in Scotland during 2008-2009

The prevalence of injection drug use has been of especial interest for assessment of the impact of blood-borne viruses. However, the incidence of injection drug use has been underresearched. Our 2-fold aim in this study was to estimate 1) how many other persons, per annum, an injection drug user (IDU) has the equivalent of full responsibility (EFR) for initiating into injection drug use and 2) the consequences for IDUs' replacement rate. EFR initiation rates are strongly associated with incarceration history, so that our analysis of IDUs' replacement rate must incorporate when, in their injecting career, IDUs were first incarcerated. To do so, we have first to estimate piecewise constant incarceration rates in conjunction with EFR initiation rates, which are then combined with rates of cessation from injecting to model IDUs' replacement rate over their injecting career, analogous to the reproduction number of an epidemic model. We apply our approach to Scotland's IDUs, using over 2,500 anonymous injector participants who were interviewed in Scotland's Needle Exchange Surveillance Initiative during 2008-2009. Our approach was made possible by the inclusion of key questions about initiations. Finally, we extend our model to include an immediate quit rate, as a reasoned compensation for higher-than-expected replacement rates, and we estimate how high initiates' quit rate should be for IDUs' replacement rate to be 1

Modeling the initiation of others into injection drug use, using data from 2,500 injectors surveyed in Scotland during 2008-2009

The prevalence of injection drug use has been of especial interest for assessment of the impact of blood-borne viruses. However, the incidence of injection drug use has been underresearched. Our 2-fold aim in this study was to estimate 1) how many other persons, per annum, an injection drug user (IDU) has the equivalent of full responsibility (EFR) for initiating into injection drug use and 2) the consequences for IDUs' replacement rate. EFR initiation rates are strongly associated with incarceration history, so that our analysis of IDUs' replacement rate must incorporate when, in their injecting career, IDUs were first incarcerated. To do so, we have first to estimate piecewise constant incarceration rates in conjunction with EFR initiation rates, which are then combined with rates of cessation from injecting to model IDUs' replacement rate over their injecting career, analogous to the reproduction number of an epidemic model. We apply our approach to Scotland's IDUs, using over 2,500 anonymous injector participants who were interviewed in Scotland's Needle Exchange Surveillance Initiative during 2008-2009. Our approach was made possible by the inclusion of key questions about initiations. Finally, we extend our model to include an immediate quit rate, as a reasoned compensation for higher-than-expected replacement rates, and we estimate how high initiates' quit rate should be for IDUs' replacement rate to be 1

Injecting equipment schemes for injecting drug users : qualitative evidence review

This review of the qualitative literature about needle and syringe programmes (NSPs) for injecting drug users (IDUs) complements the review of effectiveness and cost-effectiveness. It aims to provide a more situated narrative perspective on the overall guidance questions

Optimal control of a heroin epidemic mathematical model

A heroin epidemic mathematical model with prevention information and treatment, as control interventions, is analyzed, assuming that an individual's behavioral response depends on the spreading of information about the effects of heroin. Such information creates awareness, which helps individuals to participate in preventive education and self-protective schemes with additional efforts. We prove that the basic reproduction number is the threshold of local stability of a drug-free and endemic equilibrium. Then, we formulate an optimal control problem to minimize the total number of drug users and the cost associated with prevention education measures and treatment. We prove existence of an optimal control and derive its characterization through Pontryagin's maximum principle. The resulting optimality system is solved numerically. We observe that among all possible strategies, the most effective and cost-less is to implement both control policies.publishe

The Development and Implementation of Nurse-Managed Community-Based Medication Assisted Treatment Services for an Underserved Non-Metropolitan Northern California Community

Abstract Objectives: The purpose of this Doctorate in Nursing Practice (DNP) project was to improve health outcomes among underserved residents of Nevada county by increasing access to inter-professional team-based medication assisted therapy (MAT) for opioid use disorder. The over-arching goal of this DNP project was to develop evidence based, interdisciplinary, nurse-managed MAT services through the initiation of the pilot program for the newly developed MAT patient delivery system and the development of evidence-based nurse practitioner process protocols. Methods: This DNP project involved the coordination of an evidence-based, structured, nurse-managed MAT group on Wednesdays at Community Recovery Resources (CoRR) Grass Valley. The group was led by an interdisciplinary team and was attended by patients who were on a stable dose of an opioid agonist medication. The patients were required to attend the newly structured Wednesday group to obtain their Suboxone medication refill and any clinical concerns that the patient had or issues with their current maintenance therapy dose could be addressed by the provider at that time. Education regarding opioid use disorder, the use of Suboxone in the treatment of opioid use disorder as well as common side effects of the medication was provided during the group. The DNP author also assisted with the development of evidence-based nurse practitioner process protocols for the clinic site. Results: The retention rate for the patients in the newly developed MAT patient delivery system exceeded the established benchmark goal of 60%. The initial results of the patient satisfaction surveys regarding the MAT program were overwhelmingly positive. In addition, to accommodate the increased number of MAT patients who expressed interest in the new group format, an additional MAT group day was added on Tuesdays with plans to expand the group format to additional CoRR campuses. The results of the provider satisfaction surveys regarding the MAT program will be added once all results are received. Conclusion:Medication-assisted treatment (MAT) has proven to be the most effective evidence-based treatment option for patients with opioid dependence combined with psychosocial treatment. Treatment of opioid misuse disorder with buprenorphine and naloxone and/or buprenorphine has been proven to be safe and an effective treatment option in the office-based setting to decrease opioid use and cravings. Due to the new and evolving nature of the field of substance abuse and medication assisted treatment, it would be beneficial to obtain further research regarding best practices for providing MAT services to underserved non-metropolitan communities. Keywords: medication-assisted treatment, opioids, substance use disorder, drug abuse, heroin, overdose deaths, opioid addiction, buprenorphine, opioid related disorders, rural, primary health care, mortality, and safety net

HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey

<p>Abstract</p> <p>Background</p> <p>Ukraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs) in central Ukraine and to describe risk factors for HIV and HCV.</p> <p>Methods</p> <p>A sample of 315 IDUs was recruited using snowball sampling for a structured risk interview and HIV/HCV testing (81.9% male, 42% single, average age 28.9 years [range = 18 to 55]).</p> <p>Results</p> <p>HIV and HCV antibodies were detected in 14.0% and 73.0%, respectively, and 12.1% were seropositive for both infections. The most commonly used drug was hanka, home-made from poppy straw and often mixed with other substances including dimedrol, diazepines, and hypnotics. The average period of injecting was 8.5 years; 62.5% reported past-year sharing needles or injection equipment, and 8.0% shared with a known HIV-positive person. More than half (51.1%) reported multiple sexual partners, 12.9% buying or selling sex, and 10.5% exchanging sex and drugs in the past year. Those who shared with HIV positive partners were 3.4 times more likely to be HIV positive than those who did not. Those who front- or back-loaded were 4 times more likely to be HCV positive than those who did not.</p> <p>Conclusion</p> <p>Harm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine.</p

Bridging the data gaps in the epidemiology of hepatitis C virus infection in Malaysia using multi-parameter evidence synthesis

BACKGROUND: Collecting adequate information on key epidemiological indicators is a prerequisite to informing a public health response to reduce the impact of hepatitis C virus (HCV) infection in Malaysia. Our goal was to overcome the acute data shortage typical of low/middle income countries using statistical modelling to estimate the national HCV prevalence and the distribution over transmission pathways as of the end of 2009. METHODS: Multi-parameter evidence synthesis methods were applied to combine all available relevant data sources - both direct and indirect - that inform the epidemiological parameters of interest. RESULTS: An estimated 454,000 (95% credible interval [CrI]: 392,000 to 535,000) HCV antibody-positive individuals were living in Malaysia in 2009; this represents 2.5% (95% CrI: 2.2-3.0%) of the population aged 15-64 years. Among males of Malay ethnicity, for 77% (95% CrI: 69-85%) the route of probable transmission was active or a previous history of injecting drugs. The corresponding proportions were smaller for male Chinese and Indian/other ethnic groups (40% and 71%, respectively). The estimated prevalence in females of all ethnicities was 1% (95% CrI: 0.6 to 1.4%); 92% (95% CrI: 88 to 95%) of infections were attributable to non-drug injecting routes of transmission. CONCLUSIONS: The prevalent number of persons living with HCV infection in Malaysia is estimated to be very high. Low/middle income countries often lack a comprehensive evidence base; however, evidence synthesis methods can assist in filling the data gaps required for the development of effective policy to address the future public health and economic burden due to HCV. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0564-6) contains supplementary material, which is available to authorized users

Global Overview of Drug Demand and Supply: Latest Trends, Cross-cutting Issues

An estimated quarter of a billion people, or around 5 per cent of the global adult population, used drugs at least once in 2015. Even more worrisome is the fact that about 29.5 million of those drug users, or 0.6 per cent of the global adult population, suffer from drug use disorders. This means that their drug use is harmful to the point that they may experience drug dependence and require treatment.The magnitude of the harm caused by drug use is underlined by the estimated 28 million years of "healthy" life (disability-adjusted life years (DALYs)) lost worldwide in 2015 as a result of premature death and disability caused by drug use.Of those years lost, 17 million were attributable solely to drug use disorders across all drug types. DALYs attributable to morbidity and mortality resulting from all causes of drug use have increased overall in the past decade.Yet, with fewer than one in six persons with drug use disorders provided with treatment each year, the availability of and access to science-based services for the treatment of drug use disorders and related conditions remain limited