BackgroundHigh-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients’ failing discontinuation treatment. While there is some data supporting its effectiveness, patients’ perceptions of such an intervention have not been investigated.MethodsAn exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings. ResultsParticipants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: “Only if I can try to discontinue…and please don’t call it that,” “More stability and less criminal activity…and that is why I would try it,” and “No cure, no brain and no flash…and thus, just for everybody else!”ConclusionsSome patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.
BLOOD BORNE VIRUSES 26. Innovative community-based educational face-to-face intervention to reduce HIV, hepatitis C virus and other blood-borne infectious risks in difficult-to-reach people who inject drugs: results from the ANRS–AERLI intervention study
Perrine Roux, Jean-Marie Le Gall, Marie Debrus, Camélia Protopopescu, Khadim Ndiaye, Baptiste Demoulin, Caroline Lions, Aurelie Haas, Marion Mora, Bruno Spire, Marie Suzan-Monti and Maria Patrizia Carrieri
Aims To study the effectiveness of an educational intervention on risks associated with drug injection, comparing primary [unsafe HIV–hepatitis C virus (HCV) practices] and secondary (local complications at injecting site) end-points in harm reduction (HR) programmes offering this intervention versus HR programmes not offering it. Design This non-random clustered intervention study was conducted in nine intervention groups (programmes offering the intervention) and eight control groups (programmes not offering it). Each participant was followed-up through a telephone interview at enrolment and at 6 and 12 months.
Setting The study took place in 17 cities throughout France. Participants Of the 271 participants, 144 were enrolled into the intervention group and 127 in the control group. Of the latter, 113 received at least one educational session. Intervention A series of participant-centred face-to-face educational sessions. Each session included direct observation by trained non-governmental organization (NGO) staff or volunteers of participants’ self-injecting the psychoactive product they used habitually; analysis by the trained NGO staff or volunteers of the participant's injecting practices, identification of injection-related risks and explanation of safer injecting practices; and an educational exchange on the individual participant's injection practices and the questions he or she asked.
Measurements Primary and secondary outcomes were ‘at least one unsafe HIV–HCV practice’ and at least one injection-related complication (derived from a checklist).
Findings The proportion of participants with at least one unsafe HIV–HCV practice in the intervention group decreased significantly, from 44% at M0 to 25% at M6, as well as complications at the injection site (from 66 to 39% at M12), while in the control group it remained mainly stable. Multivariate probit analyses showed that the intervention group experienced a significant reduction in unsafe HIV–HCV practices at M6 [coefficient, 95% confidence interval (CI) = −0.73 (−1.47 to 0.01)] and in injection-related complications at M12 [coefficient, 95% CI = −1.01 (−1.77 to −0.24)], compared with the control group.
Conclusions An inexpensive and easily implemented educational intervention on risks associated with drug injection reduces significantly unsafe HIV–HCV transmission practices and injection-related complications.
Keywords: Education; HCV; HIV; injecting drug user; intervention; local complications
27. Rates of HIV and Hepatitis Infections in Clients Entering Heroin-Assisted Treatment between 2003 and 2013 and Risk Factors for Hepatitis C Infection
AbstractDickson-Spillmann M., Haug S., Uchtenhagen A., Bruggmann P., Schaub M.P.
European Addiction Research 2016:22(4);181-191 Abstract
Background/Aims We report on the rates of hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in 1,313 clients entering heroin-assisted treatment (HAT) in Switzerland from 2003 to 2013. We identify predictors of HCV infection. Methods Data were collected using questionnaires within 2 weeks of clients' first entry into HAT. Prevalence of HAV, HBV, HCV and HIV was calculated using laboratory test results collected at entry or using reports of older test results. Predictors of HCV status were identified through multiple logistic regression analysis. Results Results show stable rates of HIV-positive clients and decreasing proportions of HAV- and HBV-infected clients. In 2013, there were 12% (n = 8) HIV-, 20% (n = 12) HAV-, 20% (n = 12) HBV- and 52% HCV- (n = 34) positive clients. Vaccination against HAV and HBV had become more frequent. Predictors of positive HCV status included older age, female gender, earlier year of entry, having spent 1 month or more in detention or prison, use of injected heroin and more years of intravenous use. Conclusion Our results highlight the fact that efforts to prevent and test for infections and to promote vaccination against HAV and HBV in heroin users need to be continued.
29. Is the quality of brief motivational interventions for drug use in primary care associated with subsequent drug use?
Tibor P. Palfai, Debbie M. Cheng, Judith A. Bernstein, Joseph Palmisano, Christine A. Lloyd-Travaglini, Tracie Goodness, Richard Saitz
Addictive Behaviours 2016:56;8-14
Background Although a number of brief intervention approaches for drug use are based on motivational interviewing (MI), relatively little is known about whether the quality of motivational interviewing skills is associated with intervention outcomes.Method The current study examined whether indices of motivational interviewing skill were associated with subsequent drug use outcomes following two different MI-based brief interventions delivered in primary care; a 15 min Brief Negotiated Interview (BNI) and a 45 min adaptation of motivational interviewing (MOTIV). Audio recordings from 351 participants in a randomized controlled trial for drug use in primary care were coded using the Motivational Interviewing Treatment Integrity Scale, (MITI Version 3.1.1). Separate negative binomial regression analyses, stratified by intervention condition, were used to examine the associations between six MITI skill variables and the number of days that the participant used his/her main drug 6 weeks after study entry. Results Only one of the MITI variables (% reflections to questions) was significantly associated with the frequency of drug use in the MOTIV condition and this was opposite to the hypothesized direction (global p = 0.01, adjusted IRR 1.50, 95%CI: 1.03–2.20 for middle vs. lowest tertile [higher skill, more drug use]. None were significantly associated with drug use in the BNI condition. Secondary analyses similarly failed to find consistent predictors of better drug outcomes. Conclusion Overall, this study provides little evidence to suggest that the level of MI intervention skills are linked with better drug use outcomes among people who use drugs and receive brief interventions in primary care. Findings should be considered in light of the fact that data from the study are from negative trial of SBI and was limited to primary care patients. Future work should consider alternative ways of examining these process variables (i.e., comparing thresholds of proficient versus non-proficient skills) or considering alternative methods of coding intervention skills.
30. Treatment Access Barriers and Disparities Among Individuals with Co-Occurring Mental Health and Substance Use Disorders: An Integrative Literature Review
Mary Ann Priester, Teri Browne, Aidyn Iachini, Stephanie Clone, Dana DeHart, Kristen D. Seay
Journal of Substance Abuse Treatment 2016:61;47-59
The purpose of this integrative review is to examine and synthesize extant literature pertaining to barriers to substance abuse and mental health treatment for persons with co-occurring substance use and mental health disorders (COD). Electronic searches were conducted using ten scholarly databases. Thirty-six articles met inclusion criteria and were examined for this review. Narrative review of these articles resulted in the identification of two primary barriers to treatment access for individuals with COD: personal characteristics barriers and structural barriers. Clinical implications and directions for future research are discussed. In particular, additional studies on marginalized sub-populations are needed, specifically those that examine barriers to treatment access among older, non-White, non-heterosexual populations.
Keywords: Co-occurring; Dual diagnosis; Substance use disorders; Mental health disorders;
EPIDEMIOLOGY AND DEMOGRAPHY
31. Tobacco and e-cigarette use amongst illicit drug users in Australia
Rachel Sutherland, Natasha Sindicich, Gavin Entwistle, Elizabeth Whittaker, Amy Peacock, Allison Matthews, Raimondo Bruno, Rosa Alati, Lucy Burns
Drug and Alcohol Dependence 2016:159;35-41 Abstract
Objective To examine the rates and patterns of tobacco and e-cigarette use amongst two samples of illicit drug users in Australia. Method Data were obtained from the 2015 Illicit Drug Reporting System (IDRS) and the 2015 Ecstasy and Related Drugs Reporting System (EDRS). These studies comprised cross-sectional samples of 888 people who inject drugs (PWID) and 763 regular psychostimulant users (RPU). Results Tobacco was consumed by the majority of both samples, however, use in the 6 months preceding interview was significantly higher amongst PWID (92.2%) than RPU (82.4% [OR 2.53 95% CI 1.86–3.44]).Inversely, PWID were less likely to have a history of e-cigarette use: 31.5% of PWID reported lifetime use of e-cigarettes (vs. 57.0% of RPU [OR 0.35 95% CI 0.28–0.42]) and 18.1% reported use in the 6 months preceding interview (vs. 33.7% of RPU [OR 0.44 95% CI 0.35–0.55]). PWID were more than three times as likely than RPU to report using e-cigarettes as a smoking cessation tool (OR 3.09 95% CI 2.03–4.71), but were less likely to use e-liquids that contained nicotine (OR 0.52 95% CI 0.32–0.83). Higher levels of poly drug use, daily tobacco use, recent use of synthetic cannabinoids and employment status were found to be significantly associated with e-cigarette use. Conclusion The use of e-cigarettes was relatively common amongst Australian samples of PWID and RPU. Whilst the majority of PWID reported using e-cigarettes as a smoking cessation tool, it appears that RPU are using them for experimental or recreational purposes.
32. Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study
Robert G. Carlson, Ramzi W. Nahhas, Silvia S. Martins, Raminta Daniulaityte
Drug and Alcohol Dependence 2016:160;127-134 Abstract
Background Increases in illicit pharmaceutical opioid (PO) use have been associated with risk for transition to heroin use. We identify predictors of transition to heroin use among young, illicit PO users with no history of opioid dependence or heroin use at baseline.MethodsRespondent-driven sampling recruited 383 participants; 362 returned for at least one biannual structured interview over 36 months. Cox regression was used to test for associations between lagged predictors and hazard of transition to heroin use. Potential predictors were based on those suggested in the literature. We also computed population attributable risk (PAR) and the rate of heroin transition.ResultsOver 36 months, 27 (7.5%) participants initiated heroin use; all were white, and the rate of heroin initiation was 2.8% per year (95% CI = 1.9%–4.1%). Mean length of PO at first reported heroin use was 6.2 years (SD = 1.9). Lifetime PO dependence (AHR = 2.39, 95% CI = 1.07–5.48; PAR = 32%, 95% CI = −2% to 64%), early age of PO initiation (AHR = 3.08, 95%; CI = 1.26–7.47; PAR = 30%, 95% CI = 2%–59%), using illicit POs to get high but not to self-medicate a health problem (AHR = 4.83, 95% CI = 2.11–11.0; PAR = 38%, 95% CI = 12%–65%), and ever using PO non-orally most often (AHR = 6.57, 95% CI = 2.81–17.2; PAR = 63%, 95% CI = 31%–86%) were significant predictors. Conclusion This is one of the first prospective studies to test observations from previous cross-sectional and retrospective research on the relationship between illicit PO use and heroin initiation among young, initially non-opioid dependent PO users. The results provide insights into targets for the design of urgently needed prevention interventions.
Keywords: Illicit pharmaceutical opioid use; Heroin initiation; Opioid dependence; Time-to-event analysis; Natural history study
HEPATITIS C 33. Treatment for hepatitis C virus infection among people who inject drugs attending opioid substitution treatment and community health clinics: the ETHOS Study
Jason Grebely, Maryam Alavi, Michelle Micallef, Adrian J. Dunlop, Anne C. Balcomb, Nghi Phung, Martin D. Weltman, Carolyn A. Day, Carla Treloar, Nicky Bath, Paul S. Haber, Gregory J. Dore and on behalf of the ETHOS Study Group