Correlates of illicit methadone use in New York City: A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Despite growing concern about illicit methadone use in the US and other countries, there is little data about the prevalence and correlates of methadone use in large urban areas. We assessed the prevalence and examined correlates of lifetime and recent illicit methadone use in New York City (NYC).</p> <p>Methods</p> <p>1,415 heroin, crack, and cocaine users aged 15–40 years were recruited in NYC between 2000 and 2004 to complete interviewer-administered questionnaires.</p> <p>Results</p> <p>In multivariable logistic regression, non-injection drug users who used illicit methadone were more likely to be heroin dependent, less than daily methamphetamine users and to have a heroin using sex partner in the last two months. Injection drug users who used illicit methadone were more likely to use heroin daily, share injection paraphernalia and less likely to have been in a detoxification program and to have not used marijuana in the last six months.</p> <p>Conclusion</p> <p>The results overall suggest that illicit (or street) methadone use is likely not a primary drug of choice, but is instead more common in concert with other illicit drug use.</p

Needle Exchange Programs and Experience of Violence in an Inner City Neighborhood

Objective: To assess the association between proximity to a needle exchange program (NEP) and experience of violence in an inner city neighborhood. Methods: A cross-sectional survey of residents of Harlem, New York City provided data for this study. We used geocoding to obtain the distance between respondents and the nearest NEP. Respondents reported violence they were aware of or had personally experienced in their neighborhood. Multiple logistic regression analyses assessed the relation between violence and distance from the nearest NEP. Results: Among 220 respondents, 50.1% were African American, 39.0% were Latino, 44.7% were male, and the mean age was 44.5 years. In separate age-, race-, sex-, and income-adjusted logistic regression models, there was no significant association between (1) reporting a fight and distance from the nearest NEP (odds ratio [OR] = 1.05, p = .89); (2) robbery in the neighborhood in the previous 6 months and distance from the nearest NEP (OR = 1.13, p = .71); (3) ever having experienced violence and distance from the nearest NEP (OR = 0.72, p = .52); or (4) ever having been robbed by drug users and distance from the nearest NEP (OR = 1.05, p = .91). Conclusions: There was no consistent association between living close to NEPs and violence reported by residents of Harlem in this study. This study suggests that NEPs do not adversely affect rates of violence in their vicinity.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40339/2/Galea_Needle Exchange Programs and Experience_2001.pd

Ecstasy Use Among Hispanic and Black Substance Users in New York City

Surveillance data suggests that use of ecstasy in the U.S. is predominantly among white adolescent and young adults. To investigate ecstasy use among substance users in New York City we added questions to ongoing efforts to recruit heroin and cocaine users. Of 715 participants recruited, 58.3% were injection dug users (IDUs). The median age was 32 (range 17–64), 76.4% were male, 49.0% were currently homeless, 62.4% were Hispanic, 27.3% were black, and 34.5% were born outside the United States. Overall, 23.4% used ecstasy in their lifetime and 11.9% had used in the last-6 months. In multivariate logistic regression, correlates of lifetime ecstasy use included younger age, being born in the U.S., and current homelessness. We observed a significant interaction between injection drug use and race where, compared to black non-IDUs, Hispanic non-IDUs, and white IDUs were significantly more likely to have a history of lifetime ecstasy use while black IDUs were significantly less likely. These findings are limited to persons who use other drugs, but suggest that further investigation of ecstasy use in minority populations is warranted.http://deepblue.lib.umich.edu/bitstream/2027.42/40374/2/Ompad_Ecstasy Use Among Hispanic and Black_2005.pd

The Association Between Multiple Domains of Discriminations and Self-Assessed Health: A Multilevel Analysis of Latinos and Blacks in Four Low-Income New York City Neighborhoods

Objective. This study examines the association between discrimination due to race and other attributes (e.g., sex, age) and self-assessed mental and physical health among Latinos and blacks. Data Source. Latino and black adult participants (n5873) identified by randomdigit dialing were interviewed by telephone in four low-income neighborhoods in New York City: the South Bronx, East Harlem, Central Harlem, and Bedford-Stuyvesant. Study Design. In this cross-sectional study, generalized estimating equations were used to fit multilevelmultivariablemodels to test the association between discrimination and poor mental and physical health while controlling for socioeconomic status, access to health care, social support, smoking, and the racial and ethnic composition of each neighborhood. Principal Findings. Discrimination due to race and discrimination due to other attributes were associated with poor self-assessed mental but not physical health in separate multivariable models. Persons who experienced multiple domains of discrimination had a greater probability of reporting poor mental health than persons who experienced no discrimination. Conclusions. Discrimination due to race and other attributes was a significant correlate of mental health among Latinos and blacks independent of other accepted determinants of health.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40298/2/Stuber_The Association Between Multiple Domains_2003.pd

Preliminary Evidence of Health Care Provider Support for Naloxone Prescription as Overdose Fatality Prevention Strategy in New York City

Preliminary research suggests that naloxone (Narcan), a short-acting opiate antagonist, could be provided by prescription or distribution to heroin users to reduce the likelihood of fatality from overdose. We conducted a random postal survey of 1,100 prescription-authorized health care providers in New York City to determine willingness to prescribe naloxone to patients at risk of an opiate overdose. Among 363 nurse practitioners, physicians, and physician assistants responding, 33.4% would consider prescribing naloxone, and 29.4% were unsure. This preliminary study suggests that a substantial number of New York City health care providers would prescribe naloxone for opiate overdose prevention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40255/2/Coffin_Preliminary Evidence of Health Care Provider_2003.pd

Updating the Infection Risk Reduction Hierarchy: Preventing Transition into Injection

Current approaches to prevention of blood-borne infections in injection drug users include referral to drug abuse treatment, access to sterile syringes, bleach disinfection of injection equipment, and education about not sharing equipment. However, rates of some blood-borne infections (e.g., hepatitis C virus) remain elevated among injection drug users, especially early after initiation into injection drug use. With lower infection rates in noninjectors and transition into injection drug use occurring most commonly among these noninjectors, prevention of transition into injection drug use as an additional step to reduce risk for acquisition and transmission of blood-borne infections merits closer attention.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40275/2/Vlahov_Updating the Infection Risk Reduction Hierarchy_2004.pd

Hepatitis C Incidence- a Comparison Between Injection and Noninjection Drug Users in New York City

Hepatitis C virus (HCV) burdens injection drug users (IDUs) with prevalence estimated from 60–100% compared to around 5% among noninjection drug users (non-IDUs). We present preliminary data comparing the risk for HCV among IDUs and non-IDUs to inform new avenues of HCV prevention and intervention planning. Two cohorts, new IDUs (injecting≤ 3 years) and non-IDUs (smoke/sniff heroine, crack or cocaine≤ 10 years), ages 15–40, were street-recruited in New York City. Participants underwent risk surveys and HCV serology at baseline and 6-month follow-up visits. Person-time analysis was used to estimate annual HCV incidence. Of 683 non-IDUs, 653 were HCV seronegative, 422 returned for at least 1 follow-up visit, and 1 became HCV seropositive. Non-IDUs contributed 246.3 person-years (PY) yielding an annual incident rate of 0.4/100 PY (95% Confidence Interval [CI]=0.0-1.2). Of 260 IDUs, 114 were HCV seronegative, 62 returned for at least 1 follow-up visit, and 13 became HCV seropositive. IDUs contributed 36.3 PY yielding an annual incidence rate of 35.9/100 PY (95%CI=19.1–61.2). Among IDUs, HCV seroconverters tended to be younger (median age 25 vs. 28, respectively), and inject more frequently (61.5% vs. 34.7%, respectively) than nonseroconverters. These interim data suggest that IDUs may have engaged in high-risk practices prior to being identified for prevention services. Preventing or at least delaying transition into injection could increase opportunity to intervene. Identifying risk factors for transition into injection could inform early prevention to reduce onset of injection and risk of HCV.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40369/2/Fuller_Hepatitis C Incidence - a Comparison Betwwen Injection_2004.pd

Gender differences in sexual behaviors, sexual partnerships, and HIV among drug users in New York City

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/48789/1/absalon_gender differences in sexual behaviors_2006.pd

Association of sex, hygiene and drug equipment sharing with hepatitis C virus infection among non-injecting drug users in New York City

Background: Hepatitis C virus (HCV) rates are higher in non-injecting drug users (NIDUs) than general population estimates. Whether this elevated HCV rate is due to drug use or other putative risk behaviors remains unclear. Methods: Recent non-injection drug users of heroin, crack and/or cocaine were street-recruited from 2000 to 2003 and underwent an interview and venipuncture for HCV antibody assays. Multiple logistic regression analyses were used to assess correlates for HCV infection. Results: Of 740 enrollees, 3.9% were HCV positive. The median age (intraquartile range) was 30 (35–24) years, 70% were male and 90% were Black or Hispanic. After adjustment, HCV seropositives were significantly more likely than seronegatives to be older than 30 [adjusted odds ratio (AOR) = 5.71], tattooed by a friend/relative/acquaintance [AOR= 3.61] and know someone with HCV [AOR= 4.29], but were less likely to have shared nail or hair clippers, razors or a toothbrush [AOR= 0.32]. Conclusions: Non-commercial tattooing may be a mode of HCV transmission among NIDUs and education on the potential risk in using non-sterile tattooing equipment should be targeted toward this population. While no evidence was found for HCV transmission through NIDU equipment sharing or sexual risk behavior, further research is still warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40317/2/Howe_Association of Sex, Hygiene and Drug Equipment_2005.pd

A Comparison of HIV Seropositive and Seronegative Young Adult Heroin- and Cocaine- Using Men Who Have Sex with Men in New York City, 2000-2003

The purpose of this analysis was to determine the prevalence and correlates of HIV infection among a street-recruited sample of heroin- and cocaine-using men who have sex with men (MSM). Injection (injecting â¤3 years) and non-injection drug users (heroin, crack, and/or cocaine use <10 years) between 18 and 40 years of age were simultaneously street-recruited into two cohort studies in New York City, 2000â2003, by using identical recruitment techniques. Baseline data collected among young adult men who either identified as gay/bisexual or reported ever having sex with a man were used for this analysis. Nonparametric statistics guided interpretation. Of 95 heroin/ cocaine-using MSM, 25.3% tested HIV seropositive with 75% reporting a previous HIV diagnosis. The majority was black (46%) or Hispanic (44%), and the median age was 28 years (range 18â40). HIV-seropositive MSM were more likely than seronegatives to be older and to have an HIV-seropositive partner but less likely to report current homelessness, illegal income, heterosexual identity, multiple sex partners, female partners, and sex for money/drug partners than seronegatives. These data indicate high HIV prevalence among street-recruited, drug-using MSM compared with other injection drug use (IDU) subgroups and drug-using MSM; however, lower risk behaviors were found among HIV seropositives compared with seronegatives. Large-scale studies among illicit drug-using MSM from more marginalized neighborhoods are warranted.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/40372/2/Fuller_A Comparison of HIV Seropositive and Seronegative_2005.pd