Two hundred and thirty-six marijuana users who volunteered for a study in which they would use the drug were administered a Drug History and a Marihuana Effects Questionnaires. In addition to obtaining descriptive information of drug experiment volunteers and a factor analysis of the marijuana experience, the relationship between experience and effect variables were studied. The results of the above analysis suggest that the "typical" subject in marijuana experiments is not a "typical" user, that the marijuana experience is verbally definable, and that prior expectancies and histories of effect alter the experience.
North America's first government sanctioned supervised injection facility (SIF) was opened in Vancouver in response to the serious health and social consequences of injection drug use and the perseverance of committed advocates and drug user groups who demanded change. This analysis was conducted to describe the attendance, demographic characteristics, drug use patterns, and referrals made during the first 18 months of operation.
As part of the evaluation strategy for the SIF, information is collected through a comprehensive on-site database designed to track attendance and the daily activities within the facility. All users of the SIF must sign a waiver form and are then entered into a database using a unique identifier of their choice. This identifier is used at each subsequent visit to provide a prospective record of attendance, drug use, and interventions.
From 10 March 2004 to 30 April 2005 inclusive, there were 4764 unique individuals who registered at the SIF. The facility successfully attracted a range of community injection drug users including women (23%) and members of the Aboriginal community (18%). Although heroin was used in 46% of all injections, cocaine was injected 37% of the time. There were 273 witnessed overdoses with no fatalities. During just 12 months of observation, 2171 individual referrals were made with the majority (37%) being referred for addiction counseling.
Vancouver's SIF has successfully been integrated into the community, has attracted a wide cross section of community injection drug users, has intervened in overdoses, and initiated over 2000 referrals to counseling and other support services. These findings should be useful for other settings considering SIF trials.
Buprenorphine misuse by injecting drug users was assessed in a survey of 350 needle exchangers, either amphetamine (57%) or heroin users (42%). 89% of heroin users and 24% of amphetamine users reported using buprenorphine at some time during the previous year. Most users reported illicit acquisition. Among illicit users, 87% of heroin users reported intake for withdrawal treatment or self-detoxification, and 11% for euphoria. Euphoria seeking was more common among amphetamine users (62%, p
According to a cohort study conducted in Montréal, Québec from 1995 to 2000, the mortality rate among street youth was 921/100,000 person-years. Several new community initiatives aiming to increase access to housing and to social and health services for the homeless were implemented in the city between 2000 and 2003. This study aims to update the mortality rate estimate for the period 2001-2006 and to examine factors that could explain a difference between rates, if any. A second cohort study was conducted between 2001 and 2006. The Cohort 2 mortality rate was computed and compared with the Cohort 1 rate. Several analyses were then carried out: (1) mortality rates in the general population were compared with street youth rates using standardized mortality ratios (SMR); (2) Cohorts 1 and 2 distributions of risk factors for mortality were examined, and their effects were assessed using multivariate proportional hazards regression analyses carried out on a combined Cohorts 1 and 2 dataset. Mortality rate among street youth decreased by 79% while it declined by only 19% in the general population; the SMR for Cohort 1 was higher than for Cohort 2 (11.6 versus 3.0). Multivariate proportional hazards regression analyses yielded estimates that were close to the model's estimates based on Cohort 1 data only, and participation in Cohort 1 was an independent predictor of mortality, with an adjusted hazard ratio of 9.0. The mortality decline cannot be completely explained by a similar decrease among the general population or by a difference in distribution of risk factors for mortality between the two cohorts. Field workers suggested that the decrease in heroin consumption they had observed in the streets might have contributed to the mortality decline. We then performed additional analyses which showed that even though the proportion of street youth currently using heroin decreased significantly between 1995 and 2005, the association between heroin use and mortality was not significant (adjusted hazard ratio of 0.9; 95% CI, 0.4 to 2.3). It seems that various factors could have contributed to the decline in mortality rates among street youth, one plausible factor being the implementation of new services for the homeless. This study underscores the importance of monitoring risky behaviors among vulnerable populations to ensure that morbidity and mortality data among these populations is correctly interpreted. Setting up a system to monitor the drug market could improve the quality of information collected.
Previous studies have largely attributed the Australian heroin shortage to increases in local law enforcement efforts. Because western Canada receives heroin from similar source nations, but has not measurably increased enforcement practices or funding levels, we sought to examine trends in Canadian heroin-related indices before and after the Australian heroin shortage, which began in approximately January 2001.
During periods before and after January 2001, we examined the number of fatal overdoses and ambulance responses to heroin-related overdoses that required the use of naloxone in British Columbia, Canada. As an overall marker of Canadian supply reduction, we also examined the quantity of heroin seized during this period. Lastly, we examined trends in daily heroin use among injection drug users enrolled in the Vancouver Injection Drug Users Study (VIDUS).
There was a 35% reduction in overdose deaths, from an annual average of 297 deaths during the years 1998-2000 in comparison to an average of 192 deaths during 2001-03. Similarly, use of naloxone declined 45% in the period coinciding with the Australian heroin shortage. Interestingly, the weight of Canadian heroin seized declined 64% coinciding with the Australian heroin shortage, from an average of 184 kg during 1998-2000 to 67 kg on average during 2001-03. Among 1587 VIDUS participants, the period coinciding with the Australian heroin shortage was associated independently with reduced daily injection of heroin [adjusted odds ratio: 0.55 (95% CI: 0.50-0.61); P
New patterns of drug abuse have rapidly appeared in the Western world since the Second World War. These patterns are characterized by the rapid introduction and spread of manufactured substances adopted from medicine. Interest has been sustained among illicit users by the search for new mood altering drugs. Both recreational use and multiple drug patterns are becoming increasingly predominant. Western youth has taken the forefront in the new patterns, especially in the rise of marijuana. Sex differentials are rapidly decreasing as more females are smoking. In the United States, hallucinogens have also been abused in large amounts. This reveals an important difference from Europe, where hallucinogen abuse has been low, but amphetamine abuse has been as high or higher than in the United States. Spread has been rapid throughout the populations studied, both from the colleges to the secondary schools, and from country to country, based on current rapid methods of communication and transportation. These data are important in formulating hypotheses for study and control of both epidemic and endemic drug abuse.
Medically prescribed diacetylmorphine, the active ingredient of heroin, has been shown to be effective for the treatment of severe opioid addiction. However, there are no data regarding its effectiveness among Aboriginal heroin injectors.
The present analyses were performed using data from the NAOMI study (North American Opiate Maintenance Initiative), an open-label randomized controlled trial that compared the effectiveness of injectable diacetylmorphine (45.8%) and hydromorphone (10%) vs. oral methadone (44.2%) among long-term treatment-refractory opioid-dependent individuals. Rates of retention and response to treatment were analyzed among participants from the Vancouver site (n = 192).
Baseline profiles were similar among Aboriginal (n = 60) and non-Aboriginal (n = 132) participants except for higher HIV positive rates among Aboriginal people (23.3% vs. 8.3%). Among Aboriginal participants in the injection and methadone groups, retention rates at 12 months were 84.4% vs. 57.1% and response rates were 68.8% vs. 53.4%, respectively. Aboriginal and non-Aboriginal rates were not significantly different.
Offering treatment assisted with medically prescribed diacetylmorphine or hydromorphone to long-term treatment-refractory opioid-dependent Aboriginal people could be an effective way to attract them into and retain them in treatment as well as dramatically reduce the risk of HIV infection.