Evaluation of supervised injection facilities as an ethically sound approach to treatment of injection drug abuse

Novel approaches are needed to address the issue of injection drug use in Canada, which can have negative consequences for drug users and society. Supervised injection facilities (SIFs) are legally sanctioned facilities in Canada where drug users can receive sterile drug paraphernalia, referral to cessation programs and timely medical care if necessary. SIFs operate under the principle of harm reduction, which aims to reduce rates of infection and death due to overdose among drug users. SIFs are largely driven by the utilitarian ideal of maximizing benefit for the greatest number of people, through supervision of active drug users and appropriate referral for those wishing to quit. Deontological theory may support SIFs depending on how one applies the categorical imperative. Studies of the first SIF in North America, Insite, have shown demonstrable reductions in adverse health and societal consequences of injection drug use, rationalizing their implementation under consequentialism. SIFs are, therefore, suitable for greater adoption by the healthcare system.

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Increases in injection drug use putting drug users at risk for HIV and other blood-borne diseases

PsycEXTRA Dataset ◽

10.1037/e417382008-001 ◽

2004 ◽

Keyword(s):

At Risk ◽

Drug Use ◽

Injection Drug Use ◽

Drug Users ◽

Injection Drug

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Risk Factors for the Transition from Noninjection to Injection Drug Use and Accompanying AIDS Risk Behavior in a Cohort of Drug Users

American Journal of Epidemiology ◽

10.1093/oxfordjournals.aje.a116962 ◽

1994 ◽

Vol 139 (12) ◽

pp. 1153-1163 ◽

Cited By ~ 87

Author(s):

E. J. C. van Ameijden ◽

J. A. R. van den Hoek ◽

C. Hartgers ◽

R. A. Coutinho

Keyword(s):

Risk Factors ◽

Drug Use ◽

Risk Behavior ◽

Injection Drug Use ◽

Drug Users ◽

Injection Drug ◽

Aids Risk ◽

Aids Risk Behavior

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Brucella Endocarditis in Persons Who Inject Drugs

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa063 ◽

2020 ◽

Vol 7 (4) ◽

Author(s):

John M Cafardi ◽

Douglas Haas ◽

Thomas Lamarre ◽

Judith Feinberg

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug Users ◽

Drug Users ◽

Cardiac Involvement ◽

Injection Drug ◽

Persons Who Inject Drugs ◽

Brucella Infection

Abstract We report 2 cases of infective endocarditis in injection drug users due to Brucella infection. Although cardiac involvement is a frequent sequela of brucellosis and endocarditis is often seen with injection drug use, Brucella endocarditis in persons who inject drugs without zoonotic exposure has not been reported to date.

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Socio-Demographic Correlates of Injection Drug Use Among Male Drug Users: A Cross Sectional Study in Nepal

Journal of Community Health ◽

10.1007/s10900-014-9867-1 ◽

2014 ◽

Vol 39 (6) ◽

pp. 1124-1132 ◽

Cited By ~ 1

Author(s):

Sanjeev Raj Neupane ◽

Shiva Raj Mishra ◽

Samaj Adhikari ◽

Amod Kumar Poudyal

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Drug Users ◽

Cross Sectional Study ◽

Injection Drug ◽

Sectional Study ◽

Cross Sectional ◽

Demographic Correlates

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Inconsistent Addiction Treatment for Patients Undergoing Cardiac Surgery for Injection Drug Use-Associated Infective endocarditis

10.1101/19008482 ◽

2019 ◽

Author(s):

Max Jordan Nguemeni Tiako ◽

Seong Hong ◽

Syed Usman Bin Mahmood ◽

Makoto Mori ◽

Abeel Mangi ◽

...

Keyword(s):

Infective Endocarditis ◽

Drug Use ◽

Injection Drug Use ◽

Addiction Treatment ◽

Active Drug ◽

Tertiary Care ◽

Rehabilitation Program ◽

Injection Drug ◽

Drug Rehabilitation ◽

Significant Difference

AbstractIntroductionCases of injection drug use-related infective endocarditis (IDU-IE) requiring surgery are rising in the setting of the current U.S. opioid epidemic. We thus aimed to determine the nature of addiction interventions in the perioperative period.MethodsThis is a retrospective review of surgical IDU-IE from 2011 to 2016 at a tertiary care center in New Haven, Connecticut. The data collected included substances consumed recreationally, consultations by social work (SW), psychiatry, pharmacotherapy for addiction, and evidence of enrollment in a drug rehabilitation program upon discharge.Among patients with active drug use (ADU), we compared the 24-month survival of those who received at least one form of addiction intervention to that of those who did not.ResultsForty-two patients (75%) had active drug use. Among them, 22 used heroin. Forty-one patients (73.2%) saw SW, 17 (30.4%) saw psychiatry; 14 (25%) saw neither SW nor psychiatry.Twenty-one patients (37.5%) received methadone, 6 (10.7%) received buprenorphine, 1 (0.02%) received naltrexone; 26 (46.4%) did not receive any pharmacotherapy. Fifteen patients (26.8%) attended a drug rehabilitation program, 13 (86.7%) of whom had seen SW and 8 (53%) psychiatry. Among patients with ADU, there was no statistically significant difference in survival between those who received at least one intervention and those who did not (p=0.1 by log rank).ConclusionAddiction interventions are deployed inconsistently for patients with surgical IDU-IE. Untreated substance use disorder and recurrent endocarditis are the leading cause of death in this population. Studying best-practices for perioperative interventions in IDU-IE and establishing protocols are of the upmost importance.

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Drug Users and HIV Risk in Guatemala City, Guatemala

Journal of Drug Issues ◽

10.1177/0022042619826073 ◽

2019 ◽

Vol 49 (2) ◽

pp. 296-307 ◽

Cited By ~ 1

Author(s):

John Hembling ◽

Jane Bertrand ◽

Giovanni Melendez ◽

Laura Ponchick

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Hiv Risk ◽

Sexual Behaviors ◽

Drug Users ◽

Hiv Transmission ◽

Hiv Prevalence ◽

Injection Drug ◽

Consistent Condom ◽

Guatemala City

Injection drug use is a known risk factor for HIV transmission, but research suggests non-injection drug use also heightens HIV risk. This study measures HIV prevalence and examines sexual behavior among drug users in Guatemala City. The multiplier method and respondent-driven sampling (RDS) were used to estimate the size of the population, generating a representative sample of 299 drug users 18+ years old living in Guatemala City. The study found that drug users tended to be males with low education and income; 6% were HIV positive. Most drug users reported sexual behaviors that heightened the risk of HIV transmission like multiple sexual partners, buying or selling sex, low rates of consistent condom use, and exchanging sex for drugs. HIV prevalence is low in Guatemala, but non-injection drug use likely increases behaviors that heighten risk of HIV transmission.

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Safer and Unsafe Injection Drug Use and Sex Practices Among Injection Drug Users in Halifax, Nova Scotia

Can J Public Health ◽

10.1007/bf03405004 ◽

2002 ◽

Vol 93 (3) ◽

pp. 219-222 ◽

Cited By ~ 6

Author(s):

Lois A. Jackson ◽

Diane L. Bailey ◽

John R. Fraser ◽

J. Ken Johnson ◽

Andrea Currie ◽

...

Keyword(s):

Nova Scotia ◽

Drug Use ◽

Injection Drug Use ◽

Injection Drug Users ◽

Drug Users ◽

Injection Drug ◽

Unsafe Injection ◽

Sex Practices

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When and how do individuals transition from regular drug use to injection drug use in Uganda? Findings from a rapid assessment

Harm Reduction Journal ◽

10.1186/s12954-019-0350-2 ◽

2019 ◽

Vol 16 (1) ◽

Author(s):

Matayo Baluku ◽

Twaibu Wamala

Keyword(s):

Drug Use ◽

Injection Drug Use ◽

Drug Users ◽

Time Lag ◽

Rapid Assessment ◽

Injecting Drug Users ◽

Hcv Infection ◽

Injection Drug ◽

Structured Interviews ◽

Increased Risk

Abstract Background In Uganda, injection drug use is a growing but less studied problem. Preventing the transition to injection drug use may help prevent blood-borne viral transmission, but little is known about when and how people transition to injection drug use. A greater understanding of this transition process may aid in the country’s efforts to prevent the continued growth of injection drug use, HIV, and hepatitis C Virus (HCV) infection among people who inject drugs (PWID). Methods Using a rapid situation assessment framework, we conducted semi-structured interviews among 125 PWID (102 males and 23 females)—recruited through outreach and snow-ball sampling. Participants were interviewed about their experiences on when and how they transitioned into injection drug use and these issues were also discussed in 12 focus groups held with the participants. Results All the study participants started their drug use career with non-injecting forms including chewing, smoking, and sniffing before transitioning to injecting. Transitioning was generally described as a peer-driven and socially learnt behavior. The participants’ social networks and accessibility to injectable drugs on the market and among close friends influenced the time lag between first regular drug use and first injecting—which took an average of 4.5 years. By the age of 24, at least 81.6% (95.7% for females and 78.4% for males) had transitioned into injecting. Over 84.8% shared injecting equipment during their first injection, 47.2% started injecting because a close friend was already injecting, 26.4% desired to achieve a greater “high” (26.4%) which could reflect drug-tolerance, and 12% out of curiosity. Conclusions Over 81% non-injecting drug users in Kampala and Mbale districts transitioned into injecting by the age of 24; a process that reproduces a population of PWID but also puts them at increased risk of HIV and HCV infection. As Uganda makes efforts to introduce and/or strengthen harm reduction services, interventions targeting non-injecting drug users before they transition into injecting should be considered as a key component for HIV/HCV epidemic control efforts, and their evaluation considered in future researches.

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