- Email: [email protected]
The evolution of illicit opioid use among HIV-infected opioid users in Russia (2004–2014)
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CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
Conclusions: Findings support prior research linking increased alcohol and NPS use, along with correlations between NPS, gender and Greek membership. With the knowledge that students who use NPS obtain the drugs from peers, findings suggest that at-risk individuals are more likely to abuse stimulants because of the increased acceptability of peer NPS use. Interestingly, Big 5 personality factors did not differentiate between the groups. Future research should continue to identify personality factors that correlate with NPS use to create help deter at-risk students from using. Financial support: No funding was received. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.971 Overdose education and naloxone for patients prescribed opioids in primary care: A qualitative study Ingrid A. Binswanger 1,3,∗ , Stephen Koester 2 , Shane Mueller 1 , Edward Gardner 3 , Kristin Goddard 4 , Jason Glanz 4,5 1 Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States 2 University of Colorado Denver, Denver, CO, United States 3 Denver Health, Denver, CO, United States 4 Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States 5 Colorado School of Public Health, Aurora, CO, United States
Aims: The rate of fatal pharmaceutical opioid poisonings has increased substantially since the 1990s. Naloxone is an effective opioid antidote that can be prescribed to patients for bystander use in an overdose. Primary care clinics represent settings in which large populations of patients prescribed opioids could be reached for overdose education and naloxone prescription to prevent overdose fatalities. We investigated the knowledge, attitudes and beliefs of primary care staff about overdose education and naloxone. Methods: We conducted 10 focus groups across 3 large Colorado health systems: a network of community health centers, a managed care organization, and an academic medical center. A focus group guide was developed based on behavioral theory. Focus group transcripts were coded and analyzed for themes. Results: We enrolled 56 participants, including 31 MDs, 8 nurses/NPs, 7 pharmacists, and 10 other staff members. Clinical staff had substantial knowledge gaps about naloxone and its use in outpatient settings. Themes emerged in three constructs: knowledge, barriers and benefits. There was uncertainty about who to prescribe naloxone to and a range of logistical barriers to its use in practice. Clinical staff expressed fears about offending patients and concerns about increasing risk behaviors in people prescribed naloxone. When considering naloxone, some providers reflected critically and with discomfort on their own opioid prescribing. These barriers were balanced by beliefs that prescribing naloxone could prevent death and result in safer opioid use behaviors. Conclusions: Logistical barriers and attitudinal barriers among clinical staff will need to be addressed to enhance uptake of overdose education and naloxone prescription for patients prescribed opioids for pain. Financial support: R34DA035952. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.972
Cocaine use and sexual risk among individuals with a severe mental illness: A narrative review Todd M. Bishop 1,∗ , Stephen A. Maisto 2 , Lisham Ashrafioun 1 1 VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, United States 2 Psychology, Syracuse University, Syracuse, NY, United States
Aims: This review examined the literature on the relationship between cocaine use and high-risk sexual behavior among individuals diagnosed with a severe mental illness (SMI). Methods: A literature search was conducted using the PsycINFO and PsycARTICLES databases. Articles were included if they reported sexual risk (vaginal or anal sex without a condom), cocaine use, were peer-reviewed, written in English, and included participants diagnosed with SMI (schizophrenia, schizoaffective, or bipolar disorder). Results: The 8 articles that met criteria had a mean sample size of 122. Participants were predominantly male (63%), outpatients (7/8 articles), and had a history of homelessness (71%). Cocaine use was typically reported as either frequency of use or presence of a cocaine use disorder. Three studies collapsed condom use into a sexual risk composite variable. Cocaine use was collapsed into a general substance use variable in 4/8 articles. Studies that collapsed cocaine use into a composite variable consistently found that substance use was associated with elevated rates of high-risk sex. In contrast, 67% of studies that did not use composite variables for either cocaine or condom use showed that cocaine was unrelated to likelihood of high-risk sex. Conclusions: The direct relationship between illicit drug use and risky sexual behavior observed in other populations appears to also occur among those with a SMI. However, methodological limitations of the literature, particularly retrospective, global association study design and proclivity for using composite variables, preclude stronger conclusions regarding the relationship between cocaine and high-risk sexual behavior. Financial support: This work was supported, in part, by the Advanced Fellowship Program in Mental Health Illness Research and Treatment, VISN 2 Center of Excellence for Suicide Prevention at the Canandaigua VAMC. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.973 The evolution of illicit opioid use among HIV-infected opioid users in Russia (2004–2014) Elena Blokhina 2,∗ , E. Krupitsky 2,4 , Debbie M. Cheng 1 , Carly Bridden 3 , Alexander Walley 1 , Olga Toussova 2 , Tatiana Yaroslavtseva 2 , Natalia Gnatienko 3 , Leah Forman 1 , Jeffrey Samet 1,3 1
Boston University, Boston, MA, United States First Pavlov State Medical University, St. Petersburg, Russian Federation 3 Boston Medical Center, Boston, MA, United States 4 St. Petersburg Bekhterev Research Psychoneurological Institute, St. Petersburg, Russian Federation 2
Aims: In Russia, opioid use had been mostly limited to heroin use since the 1990s, the onset of the current Russian opioid epidemic. However, in recent years, illicit use of opioids other than heroin has emerged (e.g., methadone manufactured in underground labs). This study provides data documenting the evolution of illicit opioid use
CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
among people living with HIV in St. Petersburg, Russia since early in the Russian HIV epidemic. Methods: We examined data from four NIH-supported research studies conducted in St. Petersburg, Russia from 2004 to 2014. We included current HIV-infected opioid users from PREVENT (2004–2005, n = 17), HERMITAGE (2007–2010, n = 281), LINC (2013–2014, n = 119) and ARCH (2012–2014, n = 91) studies. Descriptive statistics were calculated for key demographic variables. Recent use (i.e., past 30 days) of heroin and other opioids was assessed in each cohort with either the Addiction Severity Index, Timeline Follow Back or modified Risk Behavior Survey. Results: These studies included members of similar birth cohorts (mean age was 24.5 years in 2004 and 33.7 in 2014). Use of any illicit opioids other than heroin increased from 6% (95% CI 0.15–29%) in 2004–2005 to 30% (95% CI: 25–36%) in 2007–2010 to 73% (95% CI: 63–82%) in 2012–2014, where– as use of any heroin decreased from 100% (95% CI: 80–100%) in 2004–2005 to 96% (95% CI: 93–98%) in 2007–2010 to 65% (95% CI: 55–75%) in 2012–2014. Conclusions: Among HIV-infected opioid users from St. Petersburg, Russia, many of whom were born around 1980, illicit use of opioids other than heroin appears to have eclipsed heroin use in the current era. Financial support: R21AA014821, R01AA016059, R01DA032082, U01AA020780, U24AA020779, and U24AA020778. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.974 Efficacy of computer and therapist brief interventions for drug users Frederic Blow 3,∗ , Amy S. Bohnert 1 , Rose Ignacio 3 , K. Barry 3 , Mark A. Ilgen 3 , Brenda M. Booth 2 , Rebecca Cunningham 1 , Maureen Walton 1 1 University of Michigan, Ann Arbor, MI, United States 2 Psychiatry, University Ark Med Sciences, Little Rock, AR, United States 3 Psychiatry, University of Michigan, Ann Arbor, MI, United States
Aims: The effectiveness of screening, brief interventions, and referral to treatment (SBIRT) strategies for illegal drug users in the Emergency Department (ED) has not been established. Among patients at an urban ED, we examined the effectiveness of several motivational-based SBIRT strategies to reduce illegal drug use. Methods: This study tested two ED-based SBIRT strategies, computer-delivered brief intervention (CBI) or therapist-delivered brief intervention (TBI), compared to Enhanced Usual Care (EUC). Randomization to these three conditions in the ED was fully crossed with randomization to a therapist-delivered “booster” session 3 months post-ED visit or a control condition. Outcomes were number of days using drugs, number of weighted-drug days, and number of days using marijuana, measured at 6 and 12 months post-baseline. We used negative binomial regression with generalized estimating equations (GEE) to evaluate intervention effects over time. Results: 780 ED patients with drug use in the prior 3 months were randomized. Results of the negative binomial models found that TBI compared to EUC had significant effects on the number of days using drugs (Effect size: −0.24, 95% Confidence Interval (CI): −0.41, −0.07, p = 0.04) and weighted drug-days (Effect size: −0.24, 95% CI: −0.41, −0.08, p = 0.03). For the number of days using marijuana, both CBI and TBI had significant effects compared to EUC among patients with marijuana use at baseline (CBI Effect size: −0.17, 95% CI: −0.34, −0.01, p = 0.04; TBI Effect size: −0.24, 95%
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CI: −0.42, −0.06, p = 0.01). For all three main outcomes, receiving the “booster” session at 3 months was not associated with drug use level overall. Conclusions: Results suggest that both computerized and therapist-delivered motivational brief interventions given to patients in the ED can be effective in reducing drug use Financial support: R01 DA026029. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.975 Does type of drug lead to quicker onset of injection? Ricky Bluthenthal 2,∗ , Daniel Chu 2 , Lynn Wenger 1 , Thomas Valente 2 , Alex Kral 1 1
RTI International, San Francisco, CA, United States Preventive Medicine, University of Southern California, Los Angeles, CA, United States 2
Aims: Injection drug use has serious health consequences. We need more information about factors related to injection onset, including whether some drugs lead to quicker injection use uptake. In the following, we examine factors associated with drug specific time-to-injection (TTI) among people who inject drugs (PWID). Methods: PWID in California participated in a cross-sectional study on injection initiation from 2011 to 2013 (N = 777). Interviews included items on age at first use and age of first injection for heroin, methamphetamine, opiate prescription misuse, and powder cocaine among others. Drug-specific TTI was calculated by subtracting age at first use of a drug from age of first injection of that drug. For those who did not inject a drug, the injection risk period was calculated by subtracting current age from age at first use of drug. Descriptive statistics and retrospective survival analysis techniques were used to describe drug-specific TTI and to examine demographic factors associated with drug specific TTI. Results: Injection onset was reported by 99% of heroin users, 85% of methamphetamine users, 80% of powder cocaine users, and 48% of opiate prescription users. Hazard ratios for first year injection onset by drug were: 1.39 for heroin (median survival time [MST] = 0.61 years), 0.67 for methamphetamine (MST = 1.00 years), 0.50 for powder cocaine (MST = 2.98 years), and 0.23 for opiate prescription misuse (MST = 16.98 years). Among powder cocaine and methamphetamine users, TTI was shorter for men (p = 0.003, 0.02, respectively). Among heroin users, TTI was shorter for Latinos (p = 0.01). Among methamphetamine and opiate prescription misuse users, TTI was shorter for whites (p = 0.007, <0.001, respectively). Conclusions: The first year of drug use generated the highest risk for transition to injection for all drugs. However, first year risk and TTI was much lower for heroin and methamphetamine users. Better understanding of drug-specific factors could lead to improved interventions to prevent injection initiation. Financial support: NIDA grant # R01DA027689. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.976
CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
Conclusions: Findings support prior research linking increased alcohol and NPS use, along with correlations between NPS, gender and Greek membership. With the knowledge that students who use NPS obtain the drugs from peers, findings suggest that at-risk individuals are more likely to abuse stimulants because of the increased acceptability of peer NPS use. Interestingly, Big 5 personality factors did not differentiate between the groups. Future research should continue to identify personality factors that correlate with NPS use to create help deter at-risk students from using. Financial support: No funding was received. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.971 Overdose education and naloxone for patients prescribed opioids in primary care: A qualitative study Ingrid A. Binswanger 1,3,∗ , Stephen Koester 2 , Shane Mueller 1 , Edward Gardner 3 , Kristin Goddard 4 , Jason Glanz 4,5 1 Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO, United States 2 University of Colorado Denver, Denver, CO, United States 3 Denver Health, Denver, CO, United States 4 Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States 5 Colorado School of Public Health, Aurora, CO, United States
Aims: The rate of fatal pharmaceutical opioid poisonings has increased substantially since the 1990s. Naloxone is an effective opioid antidote that can be prescribed to patients for bystander use in an overdose. Primary care clinics represent settings in which large populations of patients prescribed opioids could be reached for overdose education and naloxone prescription to prevent overdose fatalities. We investigated the knowledge, attitudes and beliefs of primary care staff about overdose education and naloxone. Methods: We conducted 10 focus groups across 3 large Colorado health systems: a network of community health centers, a managed care organization, and an academic medical center. A focus group guide was developed based on behavioral theory. Focus group transcripts were coded and analyzed for themes. Results: We enrolled 56 participants, including 31 MDs, 8 nurses/NPs, 7 pharmacists, and 10 other staff members. Clinical staff had substantial knowledge gaps about naloxone and its use in outpatient settings. Themes emerged in three constructs: knowledge, barriers and benefits. There was uncertainty about who to prescribe naloxone to and a range of logistical barriers to its use in practice. Clinical staff expressed fears about offending patients and concerns about increasing risk behaviors in people prescribed naloxone. When considering naloxone, some providers reflected critically and with discomfort on their own opioid prescribing. These barriers were balanced by beliefs that prescribing naloxone could prevent death and result in safer opioid use behaviors. Conclusions: Logistical barriers and attitudinal barriers among clinical staff will need to be addressed to enhance uptake of overdose education and naloxone prescription for patients prescribed opioids for pain. Financial support: R34DA035952. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.972
Cocaine use and sexual risk among individuals with a severe mental illness: A narrative review Todd M. Bishop 1,∗ , Stephen A. Maisto 2 , Lisham Ashrafioun 1 1 VA VISN 2 Center of Excellence for Suicide Prevention, Canandaigua, NY, United States 2 Psychology, Syracuse University, Syracuse, NY, United States
Aims: This review examined the literature on the relationship between cocaine use and high-risk sexual behavior among individuals diagnosed with a severe mental illness (SMI). Methods: A literature search was conducted using the PsycINFO and PsycARTICLES databases. Articles were included if they reported sexual risk (vaginal or anal sex without a condom), cocaine use, were peer-reviewed, written in English, and included participants diagnosed with SMI (schizophrenia, schizoaffective, or bipolar disorder). Results: The 8 articles that met criteria had a mean sample size of 122. Participants were predominantly male (63%), outpatients (7/8 articles), and had a history of homelessness (71%). Cocaine use was typically reported as either frequency of use or presence of a cocaine use disorder. Three studies collapsed condom use into a sexual risk composite variable. Cocaine use was collapsed into a general substance use variable in 4/8 articles. Studies that collapsed cocaine use into a composite variable consistently found that substance use was associated with elevated rates of high-risk sex. In contrast, 67% of studies that did not use composite variables for either cocaine or condom use showed that cocaine was unrelated to likelihood of high-risk sex. Conclusions: The direct relationship between illicit drug use and risky sexual behavior observed in other populations appears to also occur among those with a SMI. However, methodological limitations of the literature, particularly retrospective, global association study design and proclivity for using composite variables, preclude stronger conclusions regarding the relationship between cocaine and high-risk sexual behavior. Financial support: This work was supported, in part, by the Advanced Fellowship Program in Mental Health Illness Research and Treatment, VISN 2 Center of Excellence for Suicide Prevention at the Canandaigua VAMC. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.973 The evolution of illicit opioid use among HIV-infected opioid users in Russia (2004–2014) Elena Blokhina 2,∗ , E. Krupitsky 2,4 , Debbie M. Cheng 1 , Carly Bridden 3 , Alexander Walley 1 , Olga Toussova 2 , Tatiana Yaroslavtseva 2 , Natalia Gnatienko 3 , Leah Forman 1 , Jeffrey Samet 1,3 1
Boston University, Boston, MA, United States First Pavlov State Medical University, St. Petersburg, Russian Federation 3 Boston Medical Center, Boston, MA, United States 4 St. Petersburg Bekhterev Research Psychoneurological Institute, St. Petersburg, Russian Federation 2
Aims: In Russia, opioid use had been mostly limited to heroin use since the 1990s, the onset of the current Russian opioid epidemic. However, in recent years, illicit use of opioids other than heroin has emerged (e.g., methadone manufactured in underground labs). This study provides data documenting the evolution of illicit opioid use
CPDD 77th Annual Meeting Abstracts (2015) / Drug and Alcohol Dependence 156 (2015) e2–e101
among people living with HIV in St. Petersburg, Russia since early in the Russian HIV epidemic. Methods: We examined data from four NIH-supported research studies conducted in St. Petersburg, Russia from 2004 to 2014. We included current HIV-infected opioid users from PREVENT (2004–2005, n = 17), HERMITAGE (2007–2010, n = 281), LINC (2013–2014, n = 119) and ARCH (2012–2014, n = 91) studies. Descriptive statistics were calculated for key demographic variables. Recent use (i.e., past 30 days) of heroin and other opioids was assessed in each cohort with either the Addiction Severity Index, Timeline Follow Back or modified Risk Behavior Survey. Results: These studies included members of similar birth cohorts (mean age was 24.5 years in 2004 and 33.7 in 2014). Use of any illicit opioids other than heroin increased from 6% (95% CI 0.15–29%) in 2004–2005 to 30% (95% CI: 25–36%) in 2007–2010 to 73% (95% CI: 63–82%) in 2012–2014, where– as use of any heroin decreased from 100% (95% CI: 80–100%) in 2004–2005 to 96% (95% CI: 93–98%) in 2007–2010 to 65% (95% CI: 55–75%) in 2012–2014. Conclusions: Among HIV-infected opioid users from St. Petersburg, Russia, many of whom were born around 1980, illicit use of opioids other than heroin appears to have eclipsed heroin use in the current era. Financial support: R21AA014821, R01AA016059, R01DA032082, U01AA020780, U24AA020779, and U24AA020778. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.974 Efficacy of computer and therapist brief interventions for drug users Frederic Blow 3,∗ , Amy S. Bohnert 1 , Rose Ignacio 3 , K. Barry 3 , Mark A. Ilgen 3 , Brenda M. Booth 2 , Rebecca Cunningham 1 , Maureen Walton 1 1 University of Michigan, Ann Arbor, MI, United States 2 Psychiatry, University Ark Med Sciences, Little Rock, AR, United States 3 Psychiatry, University of Michigan, Ann Arbor, MI, United States
Aims: The effectiveness of screening, brief interventions, and referral to treatment (SBIRT) strategies for illegal drug users in the Emergency Department (ED) has not been established. Among patients at an urban ED, we examined the effectiveness of several motivational-based SBIRT strategies to reduce illegal drug use. Methods: This study tested two ED-based SBIRT strategies, computer-delivered brief intervention (CBI) or therapist-delivered brief intervention (TBI), compared to Enhanced Usual Care (EUC). Randomization to these three conditions in the ED was fully crossed with randomization to a therapist-delivered “booster” session 3 months post-ED visit or a control condition. Outcomes were number of days using drugs, number of weighted-drug days, and number of days using marijuana, measured at 6 and 12 months post-baseline. We used negative binomial regression with generalized estimating equations (GEE) to evaluate intervention effects over time. Results: 780 ED patients with drug use in the prior 3 months were randomized. Results of the negative binomial models found that TBI compared to EUC had significant effects on the number of days using drugs (Effect size: −0.24, 95% Confidence Interval (CI): −0.41, −0.07, p = 0.04) and weighted drug-days (Effect size: −0.24, 95% CI: −0.41, −0.08, p = 0.03). For the number of days using marijuana, both CBI and TBI had significant effects compared to EUC among patients with marijuana use at baseline (CBI Effect size: −0.17, 95% CI: −0.34, −0.01, p = 0.04; TBI Effect size: −0.24, 95%
e21
CI: −0.42, −0.06, p = 0.01). For all three main outcomes, receiving the “booster” session at 3 months was not associated with drug use level overall. Conclusions: Results suggest that both computerized and therapist-delivered motivational brief interventions given to patients in the ED can be effective in reducing drug use Financial support: R01 DA026029. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.975 Does type of drug lead to quicker onset of injection? Ricky Bluthenthal 2,∗ , Daniel Chu 2 , Lynn Wenger 1 , Thomas Valente 2 , Alex Kral 1 1
RTI International, San Francisco, CA, United States Preventive Medicine, University of Southern California, Los Angeles, CA, United States 2
Aims: Injection drug use has serious health consequences. We need more information about factors related to injection onset, including whether some drugs lead to quicker injection use uptake. In the following, we examine factors associated with drug specific time-to-injection (TTI) among people who inject drugs (PWID). Methods: PWID in California participated in a cross-sectional study on injection initiation from 2011 to 2013 (N = 777). Interviews included items on age at first use and age of first injection for heroin, methamphetamine, opiate prescription misuse, and powder cocaine among others. Drug-specific TTI was calculated by subtracting age at first use of a drug from age of first injection of that drug. For those who did not inject a drug, the injection risk period was calculated by subtracting current age from age at first use of drug. Descriptive statistics and retrospective survival analysis techniques were used to describe drug-specific TTI and to examine demographic factors associated with drug specific TTI. Results: Injection onset was reported by 99% of heroin users, 85% of methamphetamine users, 80% of powder cocaine users, and 48% of opiate prescription users. Hazard ratios for first year injection onset by drug were: 1.39 for heroin (median survival time [MST] = 0.61 years), 0.67 for methamphetamine (MST = 1.00 years), 0.50 for powder cocaine (MST = 2.98 years), and 0.23 for opiate prescription misuse (MST = 16.98 years). Among powder cocaine and methamphetamine users, TTI was shorter for men (p = 0.003, 0.02, respectively). Among heroin users, TTI was shorter for Latinos (p = 0.01). Among methamphetamine and opiate prescription misuse users, TTI was shorter for whites (p = 0.007, <0.001, respectively). Conclusions: The first year of drug use generated the highest risk for transition to injection for all drugs. However, first year risk and TTI was much lower for heroin and methamphetamine users. Better understanding of drug-specific factors could lead to improved interventions to prevent injection initiation. Financial support: NIDA grant # R01DA027689. http://dx.doi.org/10.1016/j.drugalcdep.2015.07.976