Towards cross-Canada monitoring of the unregulated street drug supply

Background The well-being of people who use drugs (PWUD) continues to be threatened by substances of unknown type or quantity in the unregulated street drug supply. Current efforts to monitor the drug supply are limited in population reach and comparability. This restricts capacity to identify and develop measures that safeguard the health of PWUD. This study describes the development of a low-barrier system for monitoring the contents of drugs in the unregulated street supply. Early results for pilot sites are presented and compared across regions. Methods The drug content monitoring system integrates a low-barrier survey and broad spectrum urine toxicology screening to compare substances expected to be consumed and those actually in the drug supply. The system prototype was developed by harm reduction pilot projects in British Columbia (BC) and Montreal with participation of PWUD. Data were collected from harm reduction supply distribution site clients in BC, Edmonton and Montreal between May 2018–March 2019. Survey and urine toxicology data were linked via anonymous codes and analyzed descriptively by region for trends in self-reported and detected use. Results The sample consisted of 878 participants from 40 sites across 3 regions. Reported use of substances, their detection, and concordance between the two varied across regions. Methamphetamine use was reported and detected most frequently in BC (reported: 62.8%; detected: 72.2%) and Edmonton (58.3%; 68.8%). In Montreal, high concordance was also observed between reported (74.5%) and detected (86.5%) cocaine/crack use. Among those with fentanyl detected, the percentage of participants who used fentanyl unintentionally ranged from 36.1% in BC, 78.6% in Edmonton and 90.9% in Montreal. Conclusions This study is the first to describe a feasible, scalable monitoring system for the unregulated drug supply that can contrast expected and actual drug use and compare trends across regions. The system used principles of flexibility, capacity-building and community participation in its design. Results are well-suited to meet the needs of PWUD and inform the local harm reduction services they rely on. Further standardization of the survey tool and knowledge mobilization is needed to expand the system to new jurisdictions.

Homelessness, crack use, and length of stay as predictors of planned discharge from night care in a Psychosocial Care Center

Objective: identify predictors of planned discharge to night care embracement in a Psychosocial Care Center Alcohol and Drugs (CAPS AD III). Methods: Quantitative, retrospective, and documentary study of 560 medical records of people with problems resulting from the use of alcohol and other drugs who were admitted to the hospital at night in a CAPS AD III in São Paulo, over five years. As a dependent variable, the type of discharge was used (planned or not). As independent variables, the profile of the subjects related to substance use and time in hospital. Results: 1,097 admissions were identified with 50.4% of unplanned discharge associated with homelessness (p = 0.007), problematic use crack (p = 0.015), length of reception proposed by the team (p = 0.029) and length of stay of the user (p < 0.001). Conclusion: Being homeless, problematic use of crack, and lack of user participation on the decisions regarding length of stay in CAPS AD III were associated with unplanned discharge.

A Life-Course Approach to Understanding Differential Relevance of Deviant Peers for Predicting Cocaine/Crack Use

Deviant peer association has been identified as a risk factor for cocaine/crack use. However, understanding is more limited regarding the stability in the salience of this effect across the life-course. The present study utilized the Pathways to Desistance data to test for variance in the magnitude of the relationship between deviant peer association and cocaine/crack use using mixed effects ordered logistic modeling. Results indicated that cocaine/crack use frequency varied as a quadratic function of time. The interactions between deviant peer association and age variables indicated that the magnitude of this relationship first declined during adolescence, but then increased during early adulthood. Implications are discussed.

Factors Associated with Crack Cocaine Early Initiation: A Brazilian Multicentric Study

Background: Crack cocaine is a serious public health issue, with many psychiatric and psychosocial consequences. The crack cocaine user is usually inserted in a context of great social vulnerability, often associated to violence, unstructured family functioning, antisocial peer factors and easy access to the consumption of alcohol, tobacco and illicit drugs such as crack, since an early age. Objective: To compare whether there was a relative influence of risk and protection factors in several domains on the age of onset of crack use by therapeutic community patients. Methods: This cross-sectional enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in different Brazilian states between September 2012 and September 2013. A detailed structured questionnaire was developed to be used that included investigations into possible pre-use predictive factors, such as parental monitoring in childhood, deviant behaviors and peer pressure, and subsequent factors such as deviant behaviors and involvement with crime. Student t test were performed to assess the association between associated factors and the mean age of onset of crack use. Results: The presence of constant problems in the family relationship (p=0.0020), situations of maltreatment (p=0.0162), and the presence of deviant behaviors resulted in significant differences in the age at which crack consumption began. Whereas, adolescents who had parental monitoring until the beginning of adolescence started use later (p=0.000). Conclusions: The age of onset of crack consumption seems to be influenced by numerous combinations of protective and risk factors, within a system that integrates social environments, relationship groups, individual characteristics and behavior patterns, highlighting these factors will allow the development of prevention strategies, as well as specific control strategies, both based on scientific-based information.

Female crack cocaine users under treatment at therapeutic communities in southern Brazil: characteristics, pattern of consumption, and psychiatric comorbidities

Objective To explore and describe sociodemographic characteristics, crack consumption patterns, and psychiatric comorbidities of female crack users receiving treatment at therapeutic communities. Methods This was a cross-sectional, descriptive, quantitative study. Forty-six women who abstained from crack use were assessed using a sociodemographic questionnaire, the Mini-Mental State Examination (MMSE), the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), and a profile of crack use questionnaire. Descriptive statistical analyses were conducted. Results Participants had a mean age of 31.02 years (standard deviation [SD] = 7.73), most were single (76.1%), white (67.4%) and had complete or incomplete elementary education (43.5%). Before treatment, 65.2% of the women reported using crack every day; 46.3% smoked between 10 to 30 crack rocks per week. Mean treatment time was 63.56 days (SD = 75.85), with a mean of 80.41 days of abstinence (SD = 74.52) and 3.37 previous treatments (SD = 5.49). Mean age upon crack use initiation was 22.61 years (SD = 8.06), and the most frequent motivation to start using crack was curiosity (78.3%). The mean lifetime duration of crack use was 82.26 months (SD = 74.76), and the physical complications most frequently reported were weight loss (93.5%), followed by sleep problems (87%). In this study, the most prevalent psychiatric diagnoses were major depressive episode (60.87%), followed by post-traumatic stress disorder (52.17%) and generalized anxiety disorder (13.07%). Conclusions Overall, a pattern of high consumption of crack was observed. The results show a high frequency of mood and anxiety disorders, with the highest frequencies found for major depressive episode and post-traumatic stress disorder.

CRACK COCAINE USE SCENE IN THE CAPITAL OF THE STATE OF SANTA CATARINA/BRAZIL: THE (IN)VISIBILITY OF USERS

ABSTRACT Objective: to describe the characteristics of the crack cocaine use scene, its surroundings and consequences. Method: this study was based on the Time-location Sampling methodology. Between January and June 2011, 41 crack use scenes were mapped in Florianópolis (Brazil). After randomly selecting the scenes to be observed, the days and shifts for in-depth observation were selected by lottery, for a total of 98 scenes/shifts, this atep was performed between December 2011 and March 2012. The observations were recorded in a field diary, and were examined using content analysis and discussed based on the Brazilian and international literature on the topic. Results: the results show that crack cocaine use scenes were more concentrated in the central regions of Florianópolis. Policing was very ostensive in the communities surrounding these areas, which are strongly marked by drug trafficking. Healthcare, prevention and authority actions were incipient in the locations of substance use, which shows the invisibility of crack users in society. Conclusions: more investments are needed so that public policies work to help drug users access social and healthcare services.

As principais motivações e preocupações dos dependentes acolhidos em uma comunidade terapêutica / The main motivations and concerns of dependents received in a therapeutic community

Pesquisa desenvolvida com objetivo de identificar as principais motivações e preocupações dos dependentes de crack acolhidos em uma Comunidade Terapêutica (CT) localizada na Região Metropolitana de Curitiba. Estudo transversal com amostra de 30 usuários de crack, maiores de 18 anos, em tratamento sob regime de abstinência. Coleta de dados realizada por meio de entrevista individual e aplicação de um questionário estruturado. Os dependentes em tratamento na CT são na maioria do sexo masculino, com idade entre 30 a 44 anos e nível de escolaridade médio. Dentre os entrevistados 60% residem em meio familiar, onde 93,4% não possuem vínculo empregatício. A maior parte da amostra revelou que o inicio do uso de crack ocorreu na adolescência e a curiosidade e migração de outras drogas se destacaram como os principais motivadores para o uso. A busca por tratamento foi movida pelo desejo pessoal em 80% dos casos, sendo que a 56,7% dos indivíduos apresentaram a recaída como principal preocupação. Valorizar o discurso do dependente, considerando suas motivações e temores, possibilita o fomento de políticas públicas mais efetivas de prevenção ao uso e abuso e a personalização do cuidado, além de contribuir para futuros estudos sobre o tema. ABSTRACTThis research was developed to identify the main motivations and concerns of crack addicts in a Therapeutic Community (CT) located in the Metropolitan Region of Curitiba. A cross-sectional study with a sample of 30 crack users, over 18 years of age, undergoing abstinence treatment. Data collection through individual interview and application of a structured questionnaire. The dependents in TC treatment are mostly males, aged between 30 and 44 years and average schooling level. Among the interviewees, 60% live in a family environment, where 93.4% do not have an employment relationship. Most of the sample revealed that the onset of crack use occurred in adolescence and the curiosity and migration of other drugs stood out as the main motivators for the use. The search for treatment was driven by personal desire in 80% of the cases, and 56.7% of the individuals presented relapse as the main concern. Valuing the dependent's discourse, considering their motivations and fears, allows the promotion of more effective public policies to prevent the use and abuse and personalization of care, as well as contribute to future studies on the subject.

Assessment of executive functions and inhibitory control in alcohol and crack use disorders

This study assessed executive functions and inhibitory control in alcohol and crack users, as previous research suggests an association between substance-related disorders and impaired self-regulation and impulse control. In this study, 67 men aged 18-65 years completed the following instruments: sociodemographic questionnaire, Vocabulary and Matrix Reasoning (Wechsler Abbreviated Scale of Intelligence), Five Digit Test, and Behavioral Assessment of the Dysexecutive Syndrome. Alcohol and crack users showed deficits involving processing speed, response inhibition, flexibility, abstraction, planning, and monitoring. Analysis per type of drug revealed poorer cognitive performance among alcohol users. Years of drug use were associated with planning deficits. These findings are consistent with the hypothesis of an association between drug abuse and cognitive changes. In conclusion, impairments in executive functioning and inhibitory control were found in the study samples.***Avaliação das funções executivas e controle inibitório nos transtornos por uso de álcool e crack***Este estudo investigou as funções executivas e o controle inibitório em usuários de álcool e crack, pois pesquisas prévias sugerem associação entre os transtornos relacionados a substâncias e o comprometimento das capacidades de autorregulação e de controle dos impulsos. Neste estudo, 67 homens com idades entre 18-65 anos responderam aos seguintes instrumentos: questionário sociodemográfico, Vocabulário e Raciocínio Matricial (Wechsler Abbreviated Scale of Intelligence), Five Digit Test e Behavioural Assessment of the Dysexecutive Syndrome. Os usuários de álcool e crack apresentaram déficits envolvendo velocidade de processamento, inibição de respostas, flexibilidade, abstração, planejamento e monitoramento. A análise por droga de abuso revelou desempenho cognitivo inferior entre os alcoolistas. O tempo de abuso de drogas foi associado a déficits de planejamento. Esses achados são consistentes com a hipótese de associação do abuso de drogas com alterações cognitivas. Em conclusão, foram observadas alterações do funcionamento executivo e do controle inibitório nas amostras de usuários avaliadas.