Substance Use, Hospitalizations, and Co-Occurring Disorders among Patients Transferred from a Needle Exchange Program to Opioid Maintenance Treatment

Opioid use disorders (OUD) is a relapsing condition with high mortality. Opioid maintenance treatment (OMT) reduces heroin use, and overall morbidity and mortality. The prevalence of psychiatric and substance use disorders, potential baseline predictors for psychiatric hospitalization, and psychiatric diagnoses at follow-up were investigated and may give hints about possible preventative strategies. The medical records for 71 patients were reviewed 36 months following referral to OMT from a needle exchange program (NEP). Their psychiatric diagnoses and hospitalizations were identified. Their baseline characteristics were assessed for potential differences between hospitalized versus non-hospitalized patients and between patients with and without psychiatric diagnoses in a longitudinal observational study without controls. A regression analysis was performed to identify predictors for hospitalization when controlling for OMT status. Sixty-five percent of the patients were hospitalized at least once with a psychiatric diagnosis. Substance-related reasons were prevalent, and detoxification occurred among 59% of patients, with sedative- hypnotics (benzodiazepines, zopiclone, zolpidem, and pregabalin) being the substance used by 52% of patients. Baseline use of these drugs and/or buprenorphine predicted for hospitalization when controlling for OMT status. During the follow-up period, 72% of patients met the criteria for a psychiatric diagnosis other than OUD. The prevalence of non-substance use disorders overlapping with SUD was 41%, and that overlapping with anxiety disorder was 27% of all participants. Increased attention to psychiatric co-occurring disorders in the treatment of OUD is required and the importance of addressing sedative-hypnotics use when initiating OMT is highlighted.

Women who inject drugs: barriers to their access of Needle Exchange services, and gendered experiences

<p>This thesis examines the gendered experiences of women who inject drugs, and barriers they face when accessing needle exchange services. Globally, studies suggest women access needle exchange services less than men. In New Zealand, the evidence suggests a similar situation. From the little that is known about women’s experiences in this context, studies are often quantitative, medically-based, or lack the voices of women who inject. This thesis aims to understand the gendered factors affecting the experiences of women who inject drugs. This study is a feminist, qualitative study, and employed semi-structured interviews as the data collection method. Five key participants who had injected drugs and four key informants who work with people who inject drugs were interviewed. The data from the interviews were analysed using thematic analysis. This study found that stigma presented as an overwhelming, pervasive barrier to the participants, not only in their access to needle exchange services, but also as a harm in other facets of their lives. Additionally, other barriers such as location also affected their access. The data confirms the significance of gender in their experiences and how, within a drugs context, gendered issues mirror wider society. The findings provide a platform for further research in this field and contribute to the academic understanding of a marginalised and stereotyped population. They also support the implementation of women-sensitive initiatives within needle exchange services.</p>

Women who inject drugs: barriers to their access of Needle Exchange services, and gendered experiences

<p>This thesis examines the gendered experiences of women who inject drugs, and barriers they face when accessing needle exchange services. Globally, studies suggest women access needle exchange services less than men. In New Zealand, the evidence suggests a similar situation. From the little that is known about women’s experiences in this context, studies are often quantitative, medically-based, or lack the voices of women who inject. This thesis aims to understand the gendered factors affecting the experiences of women who inject drugs. This study is a feminist, qualitative study, and employed semi-structured interviews as the data collection method. Five key participants who had injected drugs and four key informants who work with people who inject drugs were interviewed. The data from the interviews were analysed using thematic analysis. This study found that stigma presented as an overwhelming, pervasive barrier to the participants, not only in their access to needle exchange services, but also as a harm in other facets of their lives. Additionally, other barriers such as location also affected their access. The data confirms the significance of gender in their experiences and how, within a drugs context, gendered issues mirror wider society. The findings provide a platform for further research in this field and contribute to the academic understanding of a marginalised and stereotyped population. They also support the implementation of women-sensitive initiatives within needle exchange services.</p>