Is the HCV-HIV co-infection prevalence amongst injecting drug users a marker for the level of sexual and injection related HIV transmission?

BACKGROUND: Amongst injecting drug users (IDUs), HIV is transmitted sexually and parenterally, but HCV is transmitted primarily parenterally. We assess and model the antibody prevalence of HCV amongst HIV-infected IDUs (denoted as HCV-HIV co-infection prevalence) and consider whether it proxies the degree of sexual HIV transmission amongst IDUs. METHODS: HIV, HCV and HCV-HIV co-infection prevalence data amongst IDU was reviewed. An HIV/HCV transmission model was adapted. Multivariate model uncertainty analyses determined whether the model's ability to replicate observed data trends required the inclusion of sexual HIV transmission. The correlation between the model's HCV-HIV co-infection prevalence and estimated proportion of HIV infections due to injecting was evaluated. RESULTS: The median HCV-HIV co-infection prevalence (prevalence of HCV amongst HIV-infected IDUs) was 90% across 195 estimates from 43 countries. High HCV-HIV co-infection prevalences (>80%) occur in most (75%) settings, but can be lower in settings with low HIV prevalence (0.75). The model without sexual HIV transmission reproduced some data trends but could not reproduce any epidemics with high HIV/HCV prevalence ratios (>0.85) or low HCV-HIV co-infection prevalence (10%. The model with sexual HIV transmission reproduced data trends more closely. The proportion of HIV infections due to injecting correlated with HCV-HIV co-infection prevalence; suggesting that up to 80/60/90%. CONCLUSION: Substantial sexual HIV transmission may occur in many IDU populations; HCV-HIV co-infection prevalence could signify its importance

Illicit substance use among university students from seven European countries: A comparison of personal and perceived peer use and attitudes towards illicit substance use

Objective: To compare European students' personal use and approval of illicit substance use with their perceptions of peer behaviours and attitudes, and investigate whether perceptions of peer norms are associated with personal use of illicit substances and attitudes. Method: This study used baseline data fromthe Social Norms Intervention for the prevention of Polydrug usE (SNIPE) project involving 4482 students from seven European countries in 2012. Students completed an online surveywhich included questions on personal and perceived peer illicit substance use and personal and perceived peer attitude towards illicit substances. Results: 8.3% of students reported having used illicit substances at least once in their life. 49.7% of students perceived that the majority of their peers have used illicit substances more frequently than themselves. The perception was significantly associated with higher odds for personal illicit substance use (OR: 1.97, 95% CI: 1.53–2.54). The perception that the majority of peers approve illicit substance use was significantly associated with higher odds for personal approval of illicit substance use (OR: 3.47, 95% CI: 2.73–4.41). Conclusion: Students commonly perceived that their peers used illicit subtances more often than themselves. We found an association between the perceived peer norms/attitudes and reported individual behaviour/ attitudes

Legally flawed, scientifically problematic, potentially harmful: The UK Psychoactive Substance Bill

This journal has often analysed legislation in the field of drug policy. Rarely has it discussed a proposed law that has such deep problems in its legal and scientific bases. The Psychoactive Substances Bill, which is currently proceeding through the UK Parliament, will (if enacted) create a ‘blanket ban’ on the production, importation, exportation and supply of all psychoactive substances for human consumption, except for those that are specifically exempted. The Bill provides for a range of civil and criminal penalties, with a maximum seven-year prison sentence

Incarceration history is associated with HIV infection among community-recruited people who inject drugs in Europe : A propensity-score matched analysis of cross-sectional studies

Publisher Copyright: © 2023 Society for the Study of Addiction.Aims: We measured the association between a history of incarceration and HIV positivity among people who inject drugs (PWID) across Europe. Design, Setting and Participants: This was a cross-sectional, multi-site, multi-year propensity-score matched analysis conducted in Europe. Participants comprised community-recruited PWID who reported a recent injection (within the last 12 months). Measurements: Data on incarceration history, demographics, substance use, sexual behavior and harm reduction service use originated from cross-sectional studies among PWID in Europe. Our primary outcome was HIV status. Generalized linear mixed models and propensity-score matching were used to compare HIV status between ever- and never-incarcerated PWID. Findings: Among 43 807 PWID from 82 studies surveyed (in 22 sites and 13 countries), 58.7% reported having ever been in prison and 7.16% (n = 3099) tested HIV-positive. Incarceration was associated with 30% higher odds of HIV infection [adjusted odds ratio (aOR) = 1.32, 95% confidence interval (CI) = 1.09–1.59]; the association between a history of incarceration and HIV infection was strongest among PWID, with the lowest estimated propensity-score for having a history of incarceration (aOR = 1.78, 95% CI = 1.47–2.16). Additionally, mainly injecting cocaine and/or opioids (aOR = 2.16, 95% CI = 1.33–3.53), increased duration of injecting drugs (per 8 years aOR = 1.31, 95% CI = 1.16–1.48), ever sharing needles/syringes (aOR = 1.91, 95% CI = 1.59–2.28) and increased income inequality among the general population (measured by the Gini index, aOR = 1.34, 95% CI = 1.18–1.51) were associated with a higher odds of HIV infection. Older age (per 8 years aOR = 0.84, 95% CI = 0.76–0.94), male sex (aOR = 0.77, 95% CI = 0.65–0.91) and reporting pharmacies as the main source of clean syringes (aOR = 0.72, 95% CI = 0.59–0.88) were associated with lower odds of HIV positivity. Conclusions: A history of incarceration appears to be independently associated with HIV infection among people who inject drugs (PWID) in Europe, with a stronger effect among PWID with lower probability of incarceration.Peer reviewe

Over 1200 drugs-related deaths and 190,000 opiate-user-years of follow-up : relative risks by sex and age-group

Heroin users/injectors' risk of drugs-related death by sex and current age is weakly estimated both in individual cohorts of under 1000 clients, 5000 person-years or 50 drugs-related deaths and when using cross-sectional data. A workshop in Cambridge analysed six cohorts who were recruited according to a common European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) protocol from drug treatment agencies in Barcelona, Denmark, Dublin, Lisbon, Rome and Vienna in the 1990s; and, as external reference, opiate-user arrestees in France and hepatitis C diagnosed ever-injectors in Scotland in 1993-2001, both followed by database linkage to December 2001. EMCDDA cohorts recorded approximately equal numbers of drugs-related deaths (864) and deaths from other non-HIV causes (865) during 106,152 person-years of follow-up. External cohorts contributed 376 drugs-related deaths (Scotland 195, France 181) and 418 deaths from non-HIV causes (Scotland 221, France 197) during 86,417 person-years of follow-up (Scotland 22,670, France 63,747). EMCDDA cohorts reported 707 drugs-related deaths in 81,367 man-years {8.7 per 1000 person-years, 95% CI: 8.1 to 9.4} but only 157 in 24,785 person-years for females {6.3 per 1000 person-years, 95% CI: 5.4 to 7.4}. Except in external cohorts, relative risks by current age-group were not particularly strong, and more modest in Poisson regression than in cross-sectional analyses: relative risk was 1.2 (95% CI: 1.0-1.4) for 35-44 year olds compared to 15-24 year 3 olds, but 1.4 for males (95%CI: 1.2-1.6), and dramatically lower at 0.44 after the first year of follow-up (95% CI: 0.37-0.52)

Psychotropic Medications and Crash Risk in Older Drivers: A Review of the Literature

Objective. An extensive review of Australian and international literature was undertaken,examining the association between psychotropic medications and crash risk involving olderdrivers. Methods. The review summarizes the findings in experimental and epidemiological studiesrelated to (a) prevalence of psychotropic medication use among older drivers; (b) side effectsof driving under the influence of psychotropic medications; and (c) association between psychotropicmedications and crash risk for older drivers. Results. Current evidence indicates that severaltypes of psychotropic medications have the potential to impair driving ability and increasethe risk of crash involvement. A major limitation is that few studies have specifically examinedthe effects on older drivers, despite the fact that the majority of the population using psychotropicmedications are older. Discussion. More knowledge about the safety of therapeutic useof psychotropic medications is needed. Large-scale, whole-population, epidemiological studies,such as data linkage studies, may be the optimal study design

Benefits and barriers to expanding the availability of take-home naloxone in Australia: A qualitative interview study with service providers

Aims: To investigate the perspectives and experiences of service providers regarding provision of take-home naloxone to people who use opioids in Victoria, Australia. Methods: Content analysis of qualitative semi-structured interviews with 15 service providers who are either involved with take-home naloxone programs or whose work brings them in contact with people who use opioids. Findings: Statements about take-home naloxone were universally positive. Both direct and indirect benefits of take-home naloxone were described. Alongside potential reductions in opioid overdose-related harms, service providers highlighted the empowering effects of providing people who use opioids with take-home naloxone. No significant risks were described. Service providers supported the expansion of naloxone availability, but also identified several intertwined barriers to doing so. Key among these were costs, current regulations and scheduling, availability of prescribers and stigma related to illicit and injecting drug use. Conclusions: Expanding the availability of naloxone is a key component of strategies to reduce harms associated with opioid overdose. Our article provides Australian evidence of the successful operational implementation of peer-to-peer THN delivery within a range of drug primary health services and needle syringe programs. Further research is required to better understand the implications of and impediments to scale-up of this potentially life-saving public health intervention

A systematic review of the effects of novel psychoactive substances “legal highs” on people with severe mental illness

Introduction: Novel psychoactive substances (NPS) are synthetic substances that have been developed to produce altered states of consciousness and perceptions. People with severe mental illness (SMI) are more likely to use NPS than people without mental illness, but the short and long-term effects of NPS are largely unknown. Method: We systematically reviewed the literature about the effects of NPS on people with SMI. Results: We included 12 case reports, 1 cross-sectional survey and 1 qualitative study. Participants included mostly males aged between 20 and 35 years. A variety of NPS were used, including synthetic cathinones and herbs such as salvia. The most commonly reported effects of NPS were psychotic symptoms (in some cases novel in form and content to the patients’ usual symptoms) and significant changes in behaviour, including agitation, aggression and violence. Patients’ vital signs; blood pressure, pulse rate and temperature were also commonly affected. Conclusion: NPS potentially have serious effects on people with severe mental illness but our findings have limited generalisability due to a reliance on case studies. There is a paucity of evidence about the long-term effects of these substances. Further research is required to provide a better understanding about how different NPS affect patients’ mental and physical health. PROSPERO Identifier: CRD42015026944 Keywords: legal highs, novel psychoactive substances, psychotic disorders, severe mental illness, schizophrenia, systemati

Predicting cocaine consumption in Spain: A mathematical modelling approach

This is an author's accepted manuscript of an article published in “Drugs: Education, Prevention, and Policy "; Volume 18, Issue 2, 2011; copyright Taylor & Francis; available online at: http://dx.doi.org/10.3109/09687630903443299In this article, we analyse the evolution of cocaine consumption in Spain and we predict consumption trends over the next few years. Additionally, we simulate some scenarios which aim to reduce cocaine consumption in the future (sensitivity analysis). Assuming cocaine dependency is a socially transmitted epidemic disease, this leads us to propose an epidemiological-type mathematical model to study consumption evolution. Model sensitivity analysis allows us to design strategies and analyse their effects on cocaine consumption. The model predicts that 3.5% of the Spanish population will be habitual cocaine consumers by 2015. The simulations carried out suggest that cocaine consumption prevention strategies are the best policy to reduce the habitual consumer population. In this article, we show that epidemiological-type mathematical models can be a useful tool in the analysis of the repercussion of health policy proposals in the short-time future. © 2011 Informa UK Ltd.Sánchez, E.; Villanueva Micó, RJ.; Santonja, FJ.; Rubio, M. (2011). Predicting cocaine consumption in Spain: A mathematical modelling approach. Drugs: Education, Prevention, and Policy. 18(2):108-115. doi:10.3109/09687630903443299S108115182Blower, S. M., & Dowlatabadi, H. (1994). Sensitivity and Uncertainty Analysis of Complex Models of Disease Transmission: An HIV Model, as an Example. International Statistical Review / Revue Internationale de Statistique, 62(2), 229. doi:10.2307/1403510Dutra, L., Stathopoulou, G., Basden, S. L., Leyro, T. M., Powers, M. B., & Otto, M. W. (2008). A Meta-Analytic Review of Psychosocial Interventions for Substance Use Disorders. American Journal of Psychiatry, 165(2), 179-187. doi:10.1176/appi.ajp.2007.06111851Gorman, D. M., Mezic, J., Mezic, I., & Gruenewald, P. J. (2006). Agent-Based Modeling of Drinking Behavior: A Preliminary Model and Potential Applications to Theory and Practice. American Journal of Public Health, 96(11), 2055-2060. doi:10.2105/ajph.2005.063289Jódar, L., Santonja, F. J., & González-Parra, G. (2008). Modeling dynamics of infant obesity in the region of Valencia, Spain. Computers & Mathematics with Applications, 56(3), 679-689. doi:10.1016/j.camwa.2008.01.011JOHNSON, B., ROACHE, J., AITDAOUD, N., JAVORS, M., HARRISON, J., ELKASHEF, A., … BLOCH, D. (2006). A preliminary randomized, double-blind, placebo-controlled study of the safety and efficacy of ondansetron in the treatment of cocaine dependence. Drug and Alcohol Dependence, 84(3), 256-263. doi:10.1016/j.drugalcdep.2006.02.011Levin, F. R., Evans, S. M., Brooks, D. J., & Garawi, F. (2007). Treatment of cocaine dependent treatment seekers with adult ADHD: Double-blind comparison of methylphenidate and placebo. Drug and Alcohol Dependence, 87(1), 20-29. doi:10.1016/j.drugalcdep.2006.07.004Marino, S., Hogue, I. B., Ray, C. J., & Kirschner, D. E. (2008). A methodology for performing global uncertainty and sensitivity analysis in systems biology. Journal of Theoretical Biology, 254(1), 178-196. doi:10.1016/j.jtbi.2008.04.011Martcheva, M., & Castillo-Chavez, C. (2003). Diseases with chronic stage in a population with varying size. Mathematical Biosciences, 182(1), 1-25. doi:10.1016/s0025-5564(02)00184-0Nelder, J. A., & Mead, R. (1965). A Simplex Method for Function Minimization. The Computer Journal, 7(4), 308-313. doi:10.1093/comjnl/7.4.308Olsson, A., Sandberg, G., & Dahlblom, O. (2003). On Latin hypercube sampling for structural reliability analysis. Structural Safety, 25(1), 47-68. doi:10.1016/s0167-4730(02)00039-5Santonja, F. J., Tarazona, A. C., & Villanueva, R. J. (2008). A mathematical model of the pressure of an extreme ideology on a society. Computers & Mathematics with Applications, 56(3), 836-846. doi:10.1016/j.camwa.2008.01.001Schmitz, J. M., Stotts, A. L., Rhoades, H. M., & Grabowski, J. (2001). Naltrexone and relapse prevention treatment for cocaine-dependent patients. Addictive Behaviors, 26(2), 167-180. doi:10.1016/s0306-4603(00)00098-8Sharomi, O., & Gumel, A. B. (2008). Curtailing smoking dynamics: A mathematical modeling approach. Applied Mathematics and Computation, 195(2), 475-499. doi:10.1016/j.amc.2007.05.012Stotts, A. L., Mooney, M. E., Sayre, S. L., Novy, M., Schmitz, J. M., & Grabowski, J. (2007). Illusory predictors: Generalizability of findings in cocaine treatment retention research. Addictive Behaviors, 32(12), 2819-2836. doi:10.1016/j.addbeh.2007.04.020White, E., & Comiskey, C. (2007). Heroin epidemics, treatment and ODE modelling. Mathematical Biosciences, 208(1), 312-324. doi:10.1016/j.mbs.2006.10.00