Childhood emotional abuse : relationships with injection drug use and chronic pain

Background: Childhood emotional abuse is an under-researched but significant public health problem. Impacts may include a higher risk for initiating injection drug use, as indicated by emerging evidence. Yet in Canada, there is a lack of research among people who inject drugs (PWID) regarding the impact of childhood emotional abuse on chronic pain and related outcomes. As such, this thesis will examine the relationships between childhood emotional abuse, injection drug use, and adult chronic pain. Methods: A systematic literature search was undertaken to identify previous studies that investigated relationships between childhood abuse (sexual, physical, or emotional) and adult injection drug use. Drawing on longitudinal cohort data from the Vancouver Injection Drug User Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS) between June 2014 and November 2016, I employed generalized estimating equations (GEE) to examine potential associations between childhood emotional abuse and adult chronic pain among PWID (Study Two), and between childhood emotional abuse and adult pain interference among PWID with chronic pain (Study Three). Results: Among the 17 articles included in the systematic review, there was strong evidence for physical abuse increasing the risk of adult injection drug use, with mixed results for sexual and emotional abuse. Study Two included 1459 PWID. In a multivariable GEE analysis, experiencing childhood emotional abuse was significantly and positively associated with experiencing chronic pain after adjusting for other types of childhood abuse and relevant socio-demographic, drug-use, and health related confounders. Study Three followed 822 PWID with chronic pain. In a multivariable GEE analysis, childhood emotional abuse remained significantly and positively associated with pain interference after adjusting for relevant socio-demographic, drug-use, and health related confounders. In addition, a history of mental illness diagnosis partially mediated this association. Conclusions: Findings of this thesis emphasize the detrimental and long-term impact of childhood abuse. It is imperative to utilize a variety of universal and targeted approaches in order to prevent childhood abuse. The results also further strengthen the rationale for expanding trauma-informed care approaches for chronic pain management, combined with strategies to prevent or ameliorate mental illness.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat

Declining rates of health problems associated with crack smoking during the expansion of crack pipe distribution in Vancouver, Canada

Background: Crack cocaine smoking is associated with an array of negative health consequences, including cuts and burns from unsafe pipes, and infectious diseases such as HIV. Despite the well-established and researched harm reduction programs for injection drug users, little is known regarding the potential for harm reduction programs targeting crack smoking to reduce health problems from crack smoking. In the wake of recent crack pipe distribution services expansion, we utilized data from long running cohort studies to estimate the impact of crack pipe distribution services on the rates of health problems associated with crack smoking in Vancouver, Canada. Methods: Data were derived from two prospective cohort studies of community-recruited people who inject drugs in Vancouver between December 2005 and November 2014. We employed multivariable generalized estimating equations to examine the relationship between crack pipe acquisition sources and self-reported health problems associated with crack smoking (e.g., cut fingers/sores, coughing blood) among people reported smoking crack. Results: Among 1718 eligible participants, proportions of those obtaining crack pipes only through health service points have significantly increased from 7.2% in 2005 to 62.3% in 2014 (p < 0.001), while the rates of reporting health problems associated with crack smoking have significantly declined (p < 0.001). In multivariable analysis, compared to those obtaining pipes only through other sources (e.g., on the street, self-made), those acquiring pipes through health service points only were significantly less likely to report health problems from smoking crack (adjusted odds ratio: 0.82; 95% confidence interval: 0.73–0.93). Conclusions: These findings suggest that the expansion of crack pipe distribution services has likely served to reduce health problems from smoking crack in this setting. They provide evidence supporting crack pipe distribution programs as a harm reduction service for crack smokers.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacult

Factors associated with inability to access addiction treatment among people who inject drugs in Vancouver, Canada

Abstract 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

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.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofReviewedFacult