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Substance use and HIV care among Puerto Ricans living with HIV on Rikers Island
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Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
Substance use and HIV care among Puerto Ricans living with HIV on Rikers Island Tracy Pugh 1,∗ , Janet Wiersema 2 , Paul Teixeira 3 1
SMS, Mailman School of Public Health, NYC, NY, United States 2 NYC Correctional Health Services, NYC, NY, United States 3 Weill Cornell Medicine, NYC, NY, United States Aims: 23% of the Latino HIV cases in the US are among people born in PR, yet Puerto Ricans compose only 9% of the US Latino population. In New York City, Latinos with HIV experience 3 times the death rate of whites. There are also high HIV rates among Latinos incarcerated at Rikers Island, the main jail complex for NYC, an epicenter of HIV. This formative study examines the experience of HIV care among incarcerated men and women who self-identified as Puerto Rican and are affected by substance use, HIV/AIDS and the criminal justice system. Methods: 20 semi-structured interviews were conducted among adults living with HIV/AIDS on Rikers Island: 10 men, 4 women. Participants discussed experiences surrounding their diagnosis, correctional and community-based care, medication adherence, stigma, social support, criminal justice history and transnationalism. Electronic medical records were used to examine participant characteristics and medical history. Results: Nearly all participants reported substance use which intertwined with all stages of the HIV care continuum. Related themes included: linkages between drug treatment and healthcare; relapse as a recurring interrupter, or reason for delay, of healthcare; and access to supportive services in drug treatment settings. Few considered provider-related, cultural factors like ethnicity or ability to speak Spanish as pivotal to care. Experience of prejudice related to ethnicity was rarely reported. In line with the concept of familismo, family was a significant motivation for maintaining health and treatment adherence. Transnational practices were moderate in number and reported by few of the participants. Conclusions: Substance use is a major barrier to HIV treatment access and medication adherence for justice-involved Puerto Ricans living with HIV. Greater sensitivity and linkages to care are needed in drug treatment settings. Financial support: HRSA Strategic Programs of National Significance H97HA26530. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.466 Methadone maintenance therapy and comorbid substance use: A brief qualitative report Nitasha Puri ∗ , Ryan McNeil, Will Small Urban Health Research Institute, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Aims: Motivations and reasons for ongoing substance use while on methadone maintenance treatment (MMT) are not well described in the literature. There are a number of potential risks for concurrent substance use while taking methadone, and treatment options are underdeveloped. This study explores motivations, reasoning, and substance use patterns of people who are on MMT. Methods: Semi-structured qualitative interviews were conducted with 39 MMT patients in Vancouver, Canada. Individuals reporting enrolment in MMT were recruited from within two ongoing cohort studies comprised of people who use drugs. Interview transcripts were analyzed using an inductive and iterative approach.
Results: Two main categories of comorbid substance use were identified: (1) escalating or ongoing stimulant use; and (2) continued opiate use despite MMT. Respondents reported using stimulants in order to counter the sedating effects of methadone, and many acknowledged continued use from prior stimulant use disorders. In addition, some experienced the cocaine-blocking effect of methadone that has been described in previous literature, which prompted them to use more stimulants. Those who continue using opiates generally describe ambivalence toward abstinence, and some choose to stay on low dose maintenance to serve as withdrawal management but allow opiate intoxication while on MMT. Others use higher quantities of opiates in attempts to override the methadone blockade and experience intoxication. Results continue to be analyzed. Conclusions: Findings underscore the need to screen for escalating stimulant use while on MMT, as well as the need to continually explore recovery goals while on MMT. Those continuing to use opiates in addition to MMT require increased harm reduction measures. Financial support: This study was supported by the US National Institutes of Health (R01DA033147, R01DA011591, and R01DA021525). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, and by the Michael Smith Foundation for Health Research. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.467 Methamphetamine addiction vulnerability, the marked sex differences in the propensity to select methamphetamine over food reinforcement Mari Purpura ∗ , Philip Viera Psychological and Brain Sciences, University California Santa Barbara, Santa Barbara, CA, United States Aims: Recent preclinical data have demonstrated that there is substantial individual variation in the propensity to select drugs of abuse (cocaine or heroin) over a competing reinforcer (food) with the majority of individual exhibiting a strong preference for one reinforcer. Further, the distribution of individuals that prefer cocaine over food exhibits a marked sex difference with females exhibiting a higher propensity to forgo food reinforcement to obtain cocaine as compared to males. Currently, there is limited information on how subject factors may impact the selection of METH over a competing reinforcer and thus, we have begun to explore individual differences in a rat model of METH versus food choice. Methods: Briefly, rats are implanted with an intravenous catheter and then trained for METH or food reinforcement on alternating days followed by assessment of choice between these reinforcers followed by additional tests at higher doses of METH. Results: To date, the data indicate that, like cocaine, there is a high degree of individual difference in the selection of METH over food reinforcement and that this selection is dependent upon METH dose with 12.5% selecting 0.05 mg/kg/infusion METH and 37.5% selecting 0.1 mg/kg/infusion METH over food reinforcement. Conclusions: Our preliminary data also suggest that, in comparison to reports of employing drug-food choice procedures in male rats, that females exhibit higher and more plastic (i.e., dose dependent) selection between METH over a competing reinforcer. Additional studies will provide a more direct comparison between males and females as well as determine the potential contribu-
Abstracts / Drug and Alcohol Dependence 171 (2017) e2–e226
Substance use and HIV care among Puerto Ricans living with HIV on Rikers Island Tracy Pugh 1,∗ , Janet Wiersema 2 , Paul Teixeira 3 1
SMS, Mailman School of Public Health, NYC, NY, United States 2 NYC Correctional Health Services, NYC, NY, United States 3 Weill Cornell Medicine, NYC, NY, United States Aims: 23% of the Latino HIV cases in the US are among people born in PR, yet Puerto Ricans compose only 9% of the US Latino population. In New York City, Latinos with HIV experience 3 times the death rate of whites. There are also high HIV rates among Latinos incarcerated at Rikers Island, the main jail complex for NYC, an epicenter of HIV. This formative study examines the experience of HIV care among incarcerated men and women who self-identified as Puerto Rican and are affected by substance use, HIV/AIDS and the criminal justice system. Methods: 20 semi-structured interviews were conducted among adults living with HIV/AIDS on Rikers Island: 10 men, 4 women. Participants discussed experiences surrounding their diagnosis, correctional and community-based care, medication adherence, stigma, social support, criminal justice history and transnationalism. Electronic medical records were used to examine participant characteristics and medical history. Results: Nearly all participants reported substance use which intertwined with all stages of the HIV care continuum. Related themes included: linkages between drug treatment and healthcare; relapse as a recurring interrupter, or reason for delay, of healthcare; and access to supportive services in drug treatment settings. Few considered provider-related, cultural factors like ethnicity or ability to speak Spanish as pivotal to care. Experience of prejudice related to ethnicity was rarely reported. In line with the concept of familismo, family was a significant motivation for maintaining health and treatment adherence. Transnational practices were moderate in number and reported by few of the participants. Conclusions: Substance use is a major barrier to HIV treatment access and medication adherence for justice-involved Puerto Ricans living with HIV. Greater sensitivity and linkages to care are needed in drug treatment settings. Financial support: HRSA Strategic Programs of National Significance H97HA26530. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.466 Methadone maintenance therapy and comorbid substance use: A brief qualitative report Nitasha Puri ∗ , Ryan McNeil, Will Small Urban Health Research Institute, BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada Aims: Motivations and reasons for ongoing substance use while on methadone maintenance treatment (MMT) are not well described in the literature. There are a number of potential risks for concurrent substance use while taking methadone, and treatment options are underdeveloped. This study explores motivations, reasoning, and substance use patterns of people who are on MMT. Methods: Semi-structured qualitative interviews were conducted with 39 MMT patients in Vancouver, Canada. Individuals reporting enrolment in MMT were recruited from within two ongoing cohort studies comprised of people who use drugs. Interview transcripts were analyzed using an inductive and iterative approach.
Results: Two main categories of comorbid substance use were identified: (1) escalating or ongoing stimulant use; and (2) continued opiate use despite MMT. Respondents reported using stimulants in order to counter the sedating effects of methadone, and many acknowledged continued use from prior stimulant use disorders. In addition, some experienced the cocaine-blocking effect of methadone that has been described in previous literature, which prompted them to use more stimulants. Those who continue using opiates generally describe ambivalence toward abstinence, and some choose to stay on low dose maintenance to serve as withdrawal management but allow opiate intoxication while on MMT. Others use higher quantities of opiates in attempts to override the methadone blockade and experience intoxication. Results continue to be analyzed. Conclusions: Findings underscore the need to screen for escalating stimulant use while on MMT, as well as the need to continually explore recovery goals while on MMT. Those continuing to use opiates in addition to MMT require increased harm reduction measures. Financial support: This study was supported by the US National Institutes of Health (R01DA033147, R01DA011591, and R01DA021525). This research was undertaken, in part, thanks to funding from the Canada Research Chairs program through a Tier 1 Canada Research Chair in Inner City Medicine, and by the Michael Smith Foundation for Health Research. http://dx.doi.org/10.1016/j.drugalcdep.2016.08.467 Methamphetamine addiction vulnerability, the marked sex differences in the propensity to select methamphetamine over food reinforcement Mari Purpura ∗ , Philip Viera Psychological and Brain Sciences, University California Santa Barbara, Santa Barbara, CA, United States Aims: Recent preclinical data have demonstrated that there is substantial individual variation in the propensity to select drugs of abuse (cocaine or heroin) over a competing reinforcer (food) with the majority of individual exhibiting a strong preference for one reinforcer. Further, the distribution of individuals that prefer cocaine over food exhibits a marked sex difference with females exhibiting a higher propensity to forgo food reinforcement to obtain cocaine as compared to males. Currently, there is limited information on how subject factors may impact the selection of METH over a competing reinforcer and thus, we have begun to explore individual differences in a rat model of METH versus food choice. Methods: Briefly, rats are implanted with an intravenous catheter and then trained for METH or food reinforcement on alternating days followed by assessment of choice between these reinforcers followed by additional tests at higher doses of METH. Results: To date, the data indicate that, like cocaine, there is a high degree of individual difference in the selection of METH over food reinforcement and that this selection is dependent upon METH dose with 12.5% selecting 0.05 mg/kg/infusion METH and 37.5% selecting 0.1 mg/kg/infusion METH over food reinforcement. Conclusions: Our preliminary data also suggest that, in comparison to reports of employing drug-food choice procedures in male rats, that females exhibit higher and more plastic (i.e., dose dependent) selection between METH over a competing reinforcer. Additional studies will provide a more direct comparison between males and females as well as determine the potential contribu-