Bloodborne viral infection in Irish injecting drug users.

The aim of this study was to determine the prevalence of, and factors associated with, hepatitis C (HCV), hepatitis B (HBV) and HIV infections among injecting drug users (IDUs) against this background. A cross-sectional survey of participants in an addiction treatment clinic was carried out on seven hundred and thirty-five people IDU tested for antibody to HCV (anti-HCV) between September 1992 and September 1997. Socio-demographic and drug use characteristics were measured. Serology tests for anti-HCV, HBV surface antigen (HBsAg) and HIV. The vast majority (89%) commenced injecting since 1990. Prevalence of anti-HCV was 61.8% (453/733), of HBsAg was 1.0% (7/729) and of HIV was 1.2% (7/600). Logistic regression analyses indicated that longer history of injecting and increased daily drug expenditure were the only independent variables associated with significantly increased risk of HCV. The only characteristic associated with increased prevalence of HBsAg was a history of injecting prior to 1990 (3.8%, 3/80). HIV prevalence was significantly higher when aged over 24 years (3.7%, 6/162), when injecting commenced prior to 1990 (6.3%, 4/64) and when injecting over 5 years (6.5%, 4/62). The study concluded that HIV prevalence has sustained a low level in this population. Interventions which aim to halt transmission of HCV are necessary and will need to target IDU very early in their injecting careers and also those at risk of commencing to inject

Knowledge regarding Hepatitis C among injecting drug users, Drugs: Education, Prevention and Policy,

Abstract Hepatitis C (HCV) is very prevalent among injecting drug users (IDU). Control of this infection poses a major challenge to harm reduction services. Education of all IDU regarding HCV constitutes part of the harm reduction programme. We sought to assess understanding of HCV among IDU attending an addiction treatment clinic and to identify whether or not those with increased contact with health professionals demonstrated better understanding. 105 IDU were interviewed to assess their knowledge regarding modes of transmission and chronicity of HCV infection. They had first injected an average of 10.0 years previously. Interviewees were more successful at identifying activities which carried a risk of HCV transmission than they were at identifying activities which posed no risk of infection. Over one third falsely believed that one could contract HCV infection even when injecting 'safely'. Understanding of the long term nature of HCV infection was also impaired. A group on methadone maintenance for a median period of 1.4 years failed to demonstrate significantly better knowledge than those attending for a 21-day detoxification. Those in frequent contact with a GP performed less well than those without such contact. Understanding of HCV among IDU is inadequate and must improve if primary prevention efforts are to succeed. We question the value of didactic approaches to educating IDU and call for a more experiential teaching style which may be more successful at countering prevalent misconceptions

Prevalence of problem alcohol use among patients attending primary care for methadone treatment

<p>Abstract</p> <p>Background</p> <p>Problem alcohol use is associated with adverse health outcomes among current or former heroin users and primary care is providing methadone treatment for increasing numbers of this population. This study aimed todetermine the prevalence of problem alcohol use among current or former heroin users attending primary care for methadone treatment and to describe the socio-demographic characteristics and health service utilisation characteristics associated with problem alcohol uses.</p> <p>Methods</p> <p>We conducted a cross sectional survey of patients sampled from a national database of patients attending general practice for methadone treatment. Participants were recruited by their general practitioner and data was collected using an interviewer-administered questionnaire, which included the Alcohol Use Disorders Identification Test ('AUDIT'), with a score of >7 considered abnormal (ie 'AUDIT positive cases') and socio-demographic, medical and substance use characteristics.</p> <p>Results</p> <p>We interviewed 196 patients (71% of those invited, 31% of those sampled, 11% of the national database). The median age was 32 years, 55% were hepatitis C positive, 79% had used illicit drugs in the previous month and 68% were male. Sixty-eight 'AUDIT positive' cases were identified (prevalence of 35%, 95% CI = 28–41%) and these were more likely to have attended a local Emergency Department in the previous year (p < 0.05) and less likely to have attended a hospital clinic in the previous year (p < 0.05). Twenty-seven (14%) scored 20 or higher indicating possible alcohol dependence.</p> <p>Conclusion</p> <p>Problem alcohol use has a high prevalence among current or former heroin users attending primary care for methadone treatment and interventions that address this issue should be explored as a priority. Interventions that address problem alcohol use in this population should be considered as a priority, although the complex medical and psychological needs of this population may make this challenging.</p

A telephone survey of parental attitudes and behaviours regarding teenage drinking

<p>Abstract</p> <p>Background</p> <p>Irish teenagers demonstrate high rates of drunkenness and there has been a progressive fall in age of first drinking in recent decades. International research indicates that parents exert substantial influence over their teenager's drinking. We sought to determine the attitudes and behaviours of Irish parents towards drinking by their adolescent children.</p> <p>Methods</p> <p>We conducted a telephone survey of a representative sample of of 234 parents who had a teenager aged between 13 and 17 years.</p> <p>Results</p> <p>Six per cent reported that they would be unconcerned if their son or daughter was to binge drink once per month. On the issue of introducing children to alcohol in the home, 27% viewed this as a good idea while 63% disagreed with this practice. Eleven per cent of parents reported that they had given a drink to their teenager at home. Parents who drank regularly themselves, who were from higher socio-demographic groups and who lived in the east of Ireland demonstrated more permissive attitudes to teenage drinking.</p> <p>Conclusions</p> <p>We found no evidence of widespread permissive attitudes and behaviours among Irish parents. Given that parental influences have been demonstrated to exert substantial impact on teenage drinking, it may be possible to harness the concerns of Irish parents more effectively to reverse the trends of escalating alcohol related harm in Ireland.</p

Primary Care and Youth Mental Health in Ireland: Qualitative Study in Deprived Urban Areas

BACKGROUND: Mental disorders account for six of the 20 leading causes of disability worldwide with a very high prevalence of psychiatric morbidity in youth aged 15-24 years. However, healthcare professionals are faced with many challenges in the identification and treatment of mental and substance use disorders in young people (e.g. young people\u27s unwillingness to seek help from healthcare professionals, lack of training, limited resources etc.) The challenge of youth mental health for primary care is especially evident in urban deprived areas, where rates of and risk factors for mental health problems are especially common. There is an emerging consensus that primary care is well placed to address mental and substance use disorders in young people especially in deprived urban areas. This study aims to describe healthcare professionals\u27 experience and attitudes towards screening and early intervention for mental and substance use disorders among young people (16-25 years) in primary care in deprived urban settings in Ireland. METHODS: The chosen method for this qualitative study was inductive thematic analysis which involved semi-structured interviews with 37 healthcare professionals from primary care, secondary care and community agencies at two deprived urban centres. RESULTS: We identified three themes in respect of interventions to increase screening and treatment: (1) Identification is optimised by a range of strategies, including raising awareness, training, more systematic and formalised assessment, and youth-friendly practices (e.g. communication skills, ensuring confidentiality); (2) Treatment is enhanced by closer inter-agency collaboration and training for all healthcare professionals working in primary care; (3) Ongoing engagement is enhanced by motivational work with young people, setting achievable treatment goals, supporting transition between child and adult mental health services and recognising primary care\u27s longitudinal nature as a key asset in promoting treatment engagement. CONCLUSIONS: Especially in deprived areas, primary care is central to early intervention for youth mental health. Identification, treatment and continuing engagement are likely to be enhanced by a range of strategies with young people, healthcare professionals and systems. Further research on youth mental health and primary care, including qualitative accounts of young people\u27s experience and developing complex interventions that promote early intervention are priorities

Children attending addiction treatment service in Dublin, 1990-1999.

In Europe, adolescent substance misuse increased during the 1990s. Ireland had among the highest rates of substance misuse among schoolchildren in Europe. This paper seeks to describe the socio-demographic and drug misuse profile of children presenting to addiction treatment services in Dublin during the 1990s. Of the 9,874 individuals who sought addiction treatment, 1, 953 (20%) were aged less than 18 years. There was a sharp increase in the number of children after 1993. The main drug of abuse was an opiate in 48% of cases. Compared to adults, the children were more likely to be female and less likely to inject. As the decade progressed the proportion of girls increased, injecting was reported more frequently and there was a dramatic rise in heroin misuse. Child heroin users were more likely to be female and to be homeless compared with adults. This study highlights the need for a dedicated service for child drug users in Dublin

Audit of the first twelve months of Cuan Dara detoxification unit July 95 to July 96.

This report examines the success of 105 patients who were admitted to Cuan Dara in the first year of its opening. Success rates were examined by looking at the proportion of patients completing methadone detoxification, the proportion completing the full six-week inpatient programme and the proportion of patients remaining drug free after discharge. Of those admitted, 88% were unemployed, with an average age of commencing illicit drug use of 15 years. Twenty-nine percent left hospital prior to detox completion and six were dismissed for serious breach of rule. Forty one percent completed the full programme. In a follow-up survey, no data was available for 29% of those admitted. For those that could be contacted, 49% had relapsed, 26% were drug free and 25% were back on methadone. All patients who left hospital prior to detox completion had relapsed, and heroin smokers were more likely to be drug free at follow-up

Letter: Alcohol and a society in denial.

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