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Prevalence and temporal trends of crack injection among injection drug users in eastern central Canada

Prevalence and temporal trends of crack injection among injection drug users in eastern central Canada

1. Introduction Over the past 30 years, crack use has grown significantly in North America. Crack first came onto the market in the Unites States in the 1980s (Inciardi, 1987; Bourgois, 1995; Jonnes, 1996; Agar, 2003) before being introduced into Canada in the 1990s, mostly among street-based opiate users and injection drug users (IDUs) (Millson et al., 1995; Millson et al., 1998; Public Health Agency of Canada, 2006; Fischer et al., 2007; Werb et al., 2010). Although crack is first and foremost a smokeable drug, several ethnographic accounts of crack being injected have been reported since the mid-90s (Johnson and Ouellet, 1996; Bourgois, Lettiere and Quesada, 1997; Carlson, Falck and Siegal, 2000; Sterk and Elifson, 2000; Clatts et al., 2002; Lankenau et al., 2004). Unlike powder cocaine, crack is not soluble in water; therefore users who want to inject the drug use acids such as lemon juice or vinegar to dissolve it (Bourgois, Lettiere and Quesada, 1997; Carlson, Falck and Siegal, 2000; Clatts et al., 2002; Lankenau et al., 2004;).
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Safe Injection Sites and Needle Exchange Programs: An Important Part of Ensuring Health to Injection Drug Users

Safe Injection Sites and Needle Exchange Programs: An Important Part of Ensuring Health to Injection Drug Users

Conclusion Injection drug users are a part the Canadian population and therefore deserve health equity. This was taken into consideration when Justice Ian Pitfield of the BC Supreme Court ruled that the federal government could not close Insite (Vancouver Coastal Health, 2009). His decision was based on the fact that Insite is a public health initiative to which users have a constitutional right. There have been over 30 peer reviewed studies evaluating Insite in particu- lar, and many more evaluating safe injection sites in gen- eral. According to Kerr, one of these researchers, the aca- demic debate concerning the medical utility of Insite is over  (O’Connor,  2009).  Although  the  health  minister  has   expressed many concerns, these concerns have been more political and moral in nature as opposed to viewing the matter from a strictly academic standpoint. The health minister wonders if government funds should be spent on harm reduction as opposed to strict treatment and detoxi- fication programs, whether SISs promote recovery, and whether it is ethical for the government to fund a program associated with illegal substances and practices (Collier, 2008). In fact these questions have been answered in the literature. Treatment and recovery are promoted at safe injection sites, and if we look at the impact that these sites have on the user, we know the sites are an appropriate use of government funds. Further, safe injection sites and nee-
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Exploration of a crack use setting and its impact on drug users' risky drug use and sexual behaviors : the case of piaules in a Montréal neighborhood.

Exploration of a crack use setting and its impact on drug users' risky drug use and sexual behaviors : the case of piaules in a Montréal neighborhood.

5 vulnerable: they are sexually exploited and often victims of violence and rape (Inciardi, 1993; 1995; Weeks et al. 2001; Sharpe, 2005). In recent years, cities across Canada have experienced a marked increase in the use of crack cocaine (Haydon & Fischer, 2005; Fischer et al., 2006; Werb et al., 2010; Roy et al., 2012). Yet, there is a scarcity of research regarding the social organization of crack houses (or analogous drug use settings) and the role they could play in HIV and HCV transmission. Moreover, most studies on this topic have been conducted elsewhere and already date back over 15 years. According to a recent study carried out in downtown Montréal, a gradual shift started around 2003, with the crack street market overtaking the powder cocaine street market (Roy et al., 2012). In light of the risks associated with crack use, such a shift could influence the risks of infection and needs of users. To inform public health authorities and harm reduction programs, this paper explores the operational style of a specific indoor crack sale and consumption setting, and its impact on drug users’ risky sexual and drug use behaviors in a changing drug market.
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Risk factors associated with unsafe injection practices at the first injection episode among intravenous drug users in France : results from PrimInject, an Internet survey

Risk factors associated with unsafe injection practices at the first injection episode among intravenous drug users in France : results from PrimInject, an Internet survey

Additionally, unlike previous results that indicated an association between cocaine injection and higher drug use practices [59–62], the PrimInject results found that, at the first injection, the use of cocaine and other stimulants did not increase the sharing of either syringes or equipment. However, early initiation into injection (under the age of 18) was correlated with needle and equipment sharing at the time of first injection. Early injection was strongly correlated with early experience of illegal drug use (𝑝 < 0.001): among the respondents who injected before the age of 18, 45% had used an illicit drug other than cannabis at the age of 14 or younger (versus 12% of the respondents who initiated injection at the age of 18 or older). Other individual factors were not documented to assess the various dimensions of vulnerability associated with the early onset of at-risk behaviours, such as poor family relationships, family history of alcohol and drug abuse, childhood trauma, and early school dropout [63– 66]. Initiation into drug use, including injection initiation in teenage years, puts young people at increased risk of drug- related harm and calls for an update of harm reduction services to address their specific needs [67]. These results reinforce the need for early identification, referral, and intervention with young people at risk, such as the clinics for young drug users launched in France in 2004. Within this framework, a comprehensive programme for preventing a large range of addictions (e.g., tobacco, alcohol, cannabis, and video games) includes information and communication campaign and outpatient clinics adapted to young drug users and their families [68]. Early interventions, such as Screening,
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The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users

The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street-drug users

39. Garten RJ, Lai S, Zhang J, Liu W, Chen J, Vlahov D, Yu XF. Rapid transmission of hepatitis C virus among young injecting heroin users in Southern China. Int J Epidemiol 2004;33:182- 188. 40. Mansson AS, Moestrup T, Nordenfelt E, Widell A. Continued transmission of hepatitis B and C viruses, but no transmission of human immunodeficiency virus among intravenous drug users participating in a syringe/needle exchange program. Scand J Infect Dis 2000;32:253-258. 41. Brunton C, Kemp R, Raynel P, Harte D, Baker M. Cumulative incidence of hepatitis C seroconversion in a cohort of seronegative injecting drug users. N Z Med J 2000;113:98-101. 42. Bourgois P, Bruneau J. Needle exchange, HIV infection, and the politics of science: Confronting Canada's cocaine injection epidemic with participant observation. Medical Anthropology: Cross-Cultural Studies in Health and Illness 2000;18:325-350.
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Antiretroviral HIV treatment and care for injecting drug users: an evidence-based overview.

Antiretroviral HIV treatment and care for injecting drug users: an evidence-based overview.

Despite these recommendations, many governments remain reluctant to implement harm reduction interventions for IDUs because of prejudices against drug users, a lack of resources or political commitment, and difficulties in changing repressive drug policy towards an innovative public health approach. In several regions, particularly Eastern Europe and Central and South-East Asia, dramatic and large outbreaks of injecting drug use have led to the rapid spread of HIV (Rhodes et al., 1999, 2002; Kozlov, 2006, Wiessing 2006), in some cases threatening entire populations of IDUs and, possibly, the general population through sexual transmission outside IDU networks and sex work [UNAIDS, 2006]. It should be acknowledged however, that in Western countries, a shift towards public health-oriented drug policies was only achieved after acute public controversy and through strong advocacy. Some industrialised countries – such as USA, Sweden and Japan – remain reluctant to implement a comprehensive package of harm reduction activities.
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Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner vs. other city areas in Montréal, Canada

Association between neighbourhood socioeconomic characteristics and high-risk injection behaviour amongst injection drug users living in inner vs. other city areas in Montréal, Canada

Introduction Two decades of risk factor research has yielded a comprehensive understanding of the individual-level determinants of HIV and viral hepatitis C (HCV) transmission amongst injection drug users (IDU) (Backmund et al., 2005; Patrick et al., 1997; Santibanez et al., 2006). A high burden of viral outcomes and high rates of HIV and HCV transmission persist in many urban settings despite ongoing virus reduction efforts (ASSSM, 2006; Vancouver Coastal Health News Release, 2003). The limited utility of actions to curtail these viral epidemics by promoting individual behaviour change suggests a need to consider contextual factors that might positively or negatively condition high-risk injection behaviour and blood- borne transmission of HIV and HCV. A first step in assessing any such conditioning of health-related behaviour is to evaluate heterogeneity in place-based risk conditions in relation to group- and area-based differentials in risk factors and their health consequences (Daniel et al., 2008).
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Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users

Doing Research with Vulnerable Populations: The Case of Intravenous Drug Users

Vulnerability in Clinical Research on Intravenous Drug Users Determining the vulnerability of PWID is a nuanced task because there is no consistent and inherent physical vulnerability within the population. Instead, vulnerabilities can arise from multiple psychological and social factors. Importantly, drug abuse disproportionately affects poor, male, urban and ethnic minority persons [27-29]. These persons can be doubly vulnerable due to historical and current institutional forms of oppression that further diminish autonomy and increase risk of disease [29-31]. Lack of knowledge and education also contributes to vulnerability: for example, one Canadian study found that, among illicit drug users who tested positive for hepatitis C virus in two Canadian community clinics, the most common reason for not seeking treatment was a lack of information about the virus or available treatments [32].
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View of PICC Your Battles: Considering the Appropriateness of Peripherally Inserted Central Catheter (PICC) Lines for Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs)

View of PICC Your Battles: Considering the Appropriateness of Peripherally Inserted Central Catheter (PICC) Lines for Outpatient Parenteral Antimicrobial Therapy (OPAT) in Injection Drug Users (IDUs)

P a g e 2 0 | U O J M V o l u m e 7 I s s u e 1 | M a y 2 0 1 7 to consent in order to help them to make informed decisions. Care must be tailored to the individual; some IV drug users may be appropriate and reliable candidates for OPAT, while others may not be. In addition to appropriate patient selection when considering IDUs requiring OPAT, close follow-up, a compassion- ate approach, provider education, and expansion of respite pro- grams all introduce novel spaces for ongoing harm reduction and good patient care. Further research is needed to clarify best prac- tices regarding OPAT for IDUs, and to establish screening criteria and guidelines for treatment in this population.
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Distributive sharing among HIV-HCV co-infected injecting drug users: the preventive role of trust in one's physician

Distributive sharing among HIV-HCV co-infected injecting drug users: the preventive role of trust in one's physician

Even in countries that have adopted needle exchange programs (NEP) and expanded access to opioid substitution treatment (OST), the prevalence of HCV in injecting drug users (IDUs) remains extremely high (60-70%) and even higher in those HIV-infected through drug use (Jauffret-Roustide et al., 2009). Among IDUs, HCV, like HIV, is mainly transmitted through needle sharing. However, HCV is more easily transmitted than HIV because its prevalence is greater, it is more resistant to desiccation (Centers for Disease Control and Prevention", 1998) and it is also linked to the sharing of drug paraphernalia (water, filter, spoon) (Hagan et al., 2001; McCoy, Metsch, Chitwood, Shapshak, & Comerford, 1998). HCV infection can consequently occur after substantially less injection and fewer sharing episodes (Hahn et al., 2002; Miller et al., 2002). All around the world, the current harm reduction (HR) policy seems to have been less effective in controlling HCV than HIV and consequently HR packages for controlling HCV are under evaluation. Targeting HIV-HCV co-infected patients’ risk behaviors is important, as interventions on this population may have a major role in controlling the spread of both HIV and HCV. Risks involved in injection practices greatly contribute to the spread of blood-borne transmitted diseases among IDUs (Alter, 2006) .
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Cannabis use correlates of syringe sharing among injection drug users

Cannabis use correlates of syringe sharing among injection drug users

This study has several limitations that need to be mentioned. Self-report of drug use and behaviors may be suspected of causing an information bias, but it has been showed to be a reliable source of information in drug users (37) and allowed us to obtain day-to-day measures of cannabis use in the journal. Relatively little information was available to describe the injection episode. The study’s design did not allow for the determination of cannabis use chronology during injection episodes or the amount, potency and composition of cannabis that was used. Also, a relatively small number (124) of syringe sharing episode were reported in the journal. It prevented us from conducting a more complete set of analysis, which would have notably allowed examining more broadly the relation between acute cannabis use and syringe sharing for each subgroup based on cannabis use patterns, controlling for adequate covariates.
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Availability of body art facilities and body art piercing do not predict hepatitis C acquisition among injection drug users in Montreal, Canada: results from a cohort study

Availability of body art facilities and body art piercing do not predict hepatitis C acquisition among injection drug users in Montreal, Canada: results from a cohort study

Results from the current study further suggest a modest effect of socioeconomic disadvantage and social disorder in HCV transmission among IDUs. As hypothesized, recent BAP acquisition was not associated with HCV seroconversion. Of note, among the 17 participants who acquired a BAP within six months of their most recent follow up, six seroconverted to HCV, and two IDUs reported having acquired their BAP while in prison. Whether obtaining a BAP invokes an independent risk, or is rather correlated with specific high-risk taking behaviours remains to be investigated. An investigation of this premise would command a very large sample size as the attributable risk for injection drug use is likely to be low.
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Buprenorphine substitution treatment in France: Drug users' views of the doctor-user relationship.

Buprenorphine substitution treatment in France: Drug users' views of the doctor-user relationship.

L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignemen[r]

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Fixing Transnational Drug Policy Drug Prohibition in the Eyes of Comparative Law

Fixing Transnational Drug Policy Drug Prohibition in the Eyes of Comparative Law

Indeterminacy of the model International attitudes to drug offenses have been one of progressive net-widening and harsher punishment. This process reveals itself in the three successive treaties which form the bedrock of the current dug control regime. The 1961 Single Convention on Narcotic Drugs broadly identifies various behaviours for criminalisation such as the illicit cultivation, production, possession, distribution, and exportation of narcotics. 30 The 1971 Convention on Psychotropic Substances opts for an open-ended approach by requiring that ‘any action contrary to a law or regulation adopted in pursuance of (…) this Convention” shall be treated as “a punishable offence’. 31 Finally, the 1988 Convention against Illicit Traffic requires parties ‘to establish a modern code of criminal offences relating to the various aspects of illicit trafficking and to ensure that such illicit activities are dealt with as serious offences’. 32 In order to pursue this project, the 1988 Convention enumerates new criminal conducts such as property conversion and the laundering of the profits of trafficking. It ambitiously enlarges the circle of criminal liability to include all persons who induce, assist, shelter or finance the illicit consumption of drugs, and criminalizes drug users themselves. 33 Last but not least, the Convention contains extensive provisions for co-operation in respect of enforcement and prosecution of offenders.
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Gambling problems among community cocaine users

Gambling problems among community cocaine users

new problems and barriers to the resolution of addictive problems. More research is needed, particularly using longitudinal study design, to better understand the overlapping origins of these problems as well as better intervention approaches. Although different studies of clinical samples (Fernandez-Montalvo et al. 2012; Mathias et al. 2009; Petry 2005) and in the general population (El-Guebaly et al. 2006; Lorains et al. 2011 for a review) have highlighted higher prevalence of anxiety disorders and depression among problem gamblers, these findings were only partially supported by the present study. In fact, with the exception of phobic disorders, the at-risk group did not differ from non-problem gamblers. A higher prevalence of phobic disorder has also been observed in other at-risk populations such as intravenous drug users (Roy et al. 2015). Furthermore, the fact that more than half gamblers presented an anxiety disorder in the past 12 months, suggests that there may be the underlying mechanism linking anxiety disorders and PG (Desai and Potenza 2008; Kessler et al. 2008; Petry et al. 2005). Impulsivity and difficulty making decisions could also be integral to the mechanisms of these two issues (Gonzales-Ortega et al. 2013; Ochoa et al. 2013). This high comorbidity with mental health problems underlines the necessity of thoroughly assessing the full range of mental health problems whenever someone is seeking help for recovery (Lorains et al. 2011).
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Gambling Problems among Community Cocaine Users

Gambling Problems among Community Cocaine Users

new problems and barriers to the resolution of addictive problems. More research is needed, particularly using longitudinal study design, to better understand the overlapping origins of these problems as well as better intervention approaches. Although different studies of clinical samples (Fernandez-Montalvo et al. 2012; Mathias et al. 2009; Petry 2005) and in the general population (El-Guebaly et al. 2006; Lorains et al. 2011 for a review) have highlighted higher prevalence of anxiety disorders and depression among problem gamblers, these findings were only partially supported by the present study. In fact, with the exception of phobic disorders, the at-risk group did not differ from non-problem gamblers. A higher prevalence of phobic disorder has also been observed in other at-risk populations such as intravenous drug users (Roy et al. 2015). Furthermore, the fact that more than half gamblers presented an anxiety disorder in the past 12 months, suggests that there may be the underlying mechanism linking anxiety disorders and PG (Desai and Potenza 2008; Kessler et al. 2008; Petry et al. 2005). Impulsivity and difficulty making decisions could also be integral to the mechanisms of these two issues (Gonzales-Ortega et al. 2013; Ochoa et al. 2013). This high comorbidity with mental health problems underlines the necessity of thoroughly assessing the full range of mental health problems whenever someone is seeking help for recovery (Lorains et al. 2011).
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Drug-drug interactions in breast cancer patients treated with CDK4/6 inhibitors.

Drug-drug interactions in breast cancer patients treated with CDK4/6 inhibitors.

Treatment-related QTc interval prolongation on ribociclib was ob- served in patients with Rb positive advanced solid tumors or lym- phomas [15] ( Table 2 ). Such an effect is generally asymptomatic, re- versible upon drug cessation, and depends on the administered dose, occurring in 9% of patients treated with 600 mg/day 3-weeks on/1- week off and in 33% of those receiving higher ribociclib doses [15] . Patients receiving ribociclib therefore undergo electrocardiograms and electrolytes monitoring prior to initiation of treatment and during follow-up. Furthermore, the risk of an additive adverse reaction should be carefully taken into account in ribociclib-treated patients having other conditions associated to QTc interval prolongation [25] . The risk of Torsade de pointes (TdP) does not seem to be a class effect since no QTc prolongation events were observed in patients treated with abe- maciclib or palbociclib [26] . The mechanism of drug-induced QTc prolongation involves the human ether-a-go-go-related gene (hERG) that encodes the pore-forming subunit of the rapidly activating delayed rectifier potassium channel (IKr), which is important for cardiac re- polarization. Dysfunction of hERG causes long QT syndrome and sudden death, which occur in patients with cardiac ischemia [27] . All drugs known to prolong the QT interval were shown to block the hERG
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Protecting vulnerable road users from injury.

Protecting vulnerable road users from injury.

The prevention of pedestrians’ injuries is more complex, as walking in the street is often considered a common life activity carrying no particular hazard. Those with immature or impaired perception and cognitive skill (children, elderly, alcohol- intoxicated pedestrians) are particularly vulnerable. New four-wheeler vehicles are increasingly designed to be less injurious to pedestrians and other VRUs. However, if designing safer car fronts is important, we will have to wait for several years to record a significant impact on morbidity and mortality statistics, especial- ly in developing countries, where vehicles are older. Vehicle onboard advanced sensing systems are currently being devel- oped to track road users and assist in preventing or reducing pedestrian injuries. However, while technology-based strate- gies (including the design of safer car fronts) might have a significant impact on VRU fatalities in industrialised countries, their costs will limit their use in developing and middle-income countries [40], where they are the most needed.
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Drug-induced thyroid dysfunction

Drug-induced thyroid dysfunction

Sometimes, transient destructive thyrotoxicosis with T-cell infiltrate in thyroid but negative thyroid Ab (pure cell-mediated autoimmunity). Treatment: LT4[r]

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The Drug testing virus

The Drug testing virus

63 This was not lost on unions who contested FPM Letter 792-16 on the grounds that it did not meet the notice and comment requirements of the Federal Admin- istrative Procedure Act , 5 U.S.C. § 553. In National Treasury Employees Union v. Reagan , 685 F. Supp. 1346, at 1355, the U.S. District Court found that “FPM Letter 792-16… guides agencies on implementation of the Executive Order and is a binding legislative rule. The Federal Personnel Manual Letter was not issued in accordance with the Administrative Procedure Act and is invalid.” When the union sought to have the implementation of FPM Letter 792-16 halted until the notice and comment requirements had been met, the Court refused, citing that “...due to the strong interests promoted by drug testing of sensitive public employees… it would be unnecessarily disruptive to enjoin implementation of the plans while the agencies comply with the APA procedures.” Instead, the Court simply ordered the Office of Personnel Management to notify the plaintiff union and accept its comments. (1988) WL 106328: WestLaw, 1.
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