Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review

Degenhardt, Louisa; Webb, Paige; Colledge-Frisby, Samantha; Ireland, Jeremy; Wheeler, Alice; Ottaviano, Sophie; Willing, Alex; Kairouz, Abe; Cunningham, Evan B; Hajarizadeh, Behzad; Leung, Janni; Tran, Lucy Thi; Price, Olivia; Peacock, Amy; Vickerman, Peter; Farrell, Michael; Dore, Gregory J.; Hickman, Matthew; Grebely, Jason

doi:10.1016/s2214-109x(23)00057-8

Cited by 95 publications

(30 citation statements)

References 42 publications

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“…1 b). More participants (88.1% [ 1 ], 77.5–93.8%) who were living within a 5 km radius compared to (48% [ 1 ], 42.1–53.6%) of those who lived more than 5 km away from the clinic completed 12 months in the programme. There were, however, no differences in the retention of participants based on their demographic, social, clinical, and psychiatric characteristics (Table 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…Opioid use disorder is associated with physiological, behavioural, and social consequences such as premature mortality, criminality, violence, and suicide [ 1 , 2 ]. Additionally, injecting drug use is associated with an increased occurrence of drug overdose, risk of HIV and Hepatitis C infections and a key driver of the HIV epidemic [ 1 , 3 – 5 ]. Further, people who inject drugs (PWID) experience stigma and social exclusion that hinder them from accessing social services and healthcare [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Retention of people who inject drugs enrolled in a ‘medications for opioid use disorder’ (MOUD) programme in Uganda

Mudiope,

Mutamba,

Komuhangi

et al. 2024

Addict Sci Clin Pract

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Background Injection Drug use is associated with increased HIV risk behaviour that may result in the transmission of HIV and poor access to HIV prevention and treatment. In 2020, Uganda introduced the ‘medication for opioid use disorder (MOUD) treatment’ for People who inject drugs (PWID). We analysed the 12-month retention and associated factors among PWID enrolled on MOUD treatment in Kampala, Uganda. Methods We conducted a retrospective analysis of 343 PWID with OUD who completed 14 days of methadone induction from September 2020 to July 2022. Retention was defined as the number of individuals still in the programme divided by the total number enrolled, computed at 3-, 6-, 9-, and 12 months using lifetable and Kaplan-Meier survival analyses. Cox proportional regression analyses were conducted to assess factors associated with retention in the programme in the first 12 months. Results Overall, 243 (71%) of 343 participants stabilized at a methadone dose of 60 mg or more. The majority of participants were males (n = 284, 82.8%), and the median (interquartile range, IQR) age was 31 (26–38) years. Most participants (n = 276, 80.5%) lived 5 km or more away from the MOUD clinic. Thirty (8.8%) were HIV-positive, 52 (15.7%) had a major mental illness and 96 (27.9%) had a history of taking alcohol three months before enrollment. The cumulative retention significantly declined from 83.4% (95%CI = 79.0–87.0) at 3months to 71.9% (95%CI = 67.2–76.6) at 6months, 64% 95%CI = 58.7–68.9) at 9months, and 55.2%; 95% CI (49.8–60.3% at 12months. The 12-month retention was significantly higher for participants on methadone doses of 60 mg or more (adj.HR = 2.1, 95%CI = 1.41–3.22), while participants resident within 5 km of the MOUD clinic were 4.9 times more likely to be retained at 12 months, compared to those residing 5 km or more, (adj. HR = 4.81, 95%CI = 1.54-15). Other factors, including predisposing, need, and enabling factors, were not associated with retention. Conclusion Our study demonstrates acceptable 12-month retention rates for people who inject drugs, comparable to previous studies done in both developing and developed countries. Sustaining and improving retention may require enhanced scaling up of MOUD dose to an optimal level in the first 14 days and reducing the distance between participant locale and MOUD clinics.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retention of people who inject drugs enrolled in a ‘medications for opioid use disorder’ (MOUD) programme in Uganda

Mudiope,

Mutamba,

Komuhangi

et al. 2024

Addict Sci Clin Pract

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“…(0.73, 1.96) 2.17 1.08 (0.88, 1. Harm reduction, which took off in part as a public health response because of the HIV/AIDS epidemic in other regions [57,58], is scarce in Chile and Latin America outside of the official treatment system, which could be explained by how low opioid and injection drug use prevalences are [37]. A harm reduction approach acknowledges that not all patients will respond or seek treatment, concentrating efforts on tackling the harms associated with substance use [59].…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, most research regarding treatment utilization takes place in high-income countries, where drug supply, patterns of misuse and healthcare delivery differ from the ones in the global South and other low and middle-income regions. In Latin America, both the prevalence of opioid and injection drug use are low [36,37]. However, cocaine is mostly produced in the Andes mountain range, making tobacco, alcohol, cocaine and cocaine derivates (including cocaine paste, a smokable intermediary product in the extraction of cocaine from coca leaves) [38] the main public health concerns [36].…”

Section: Introductionmentioning

confidence: 99%

Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

Bórquez,

Cerdá,

González‐Santa Cruz

et al. 2024

Addiction

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Background and aimsLongitudinal studies have revealed that substance use treatment use is often recurrent among patients; the longitudinal patterns and characteristics of those treatment trajectories have received less attention, particularly in the global south. This study aimed to disentangle heterogeneity in treatment use among adult patients in Chile by identifying distinct treatment trajectory groups and factors associated with them.DesignNational‐level registry‐based retrospective cohort.Setting and participantsAdults admitted to publicly funded substance use disorder treatment programs in Chile from November 2009 to November 2010 and followed for 9 years (n = 6266).MeasurementsMonthly treatment use; type of treatment; ownership of the treatment center; discharge status; primary substance used; sociodemographic.FindingsA seven‐class treatment trajectory solution was chosen using latent class growth analysis. We identified three trajectory groups that did not recur and had different treatment lengths: Early discontinuation (32%), Less than a year in treatment (19.7%) and Year‐long episode, without recurrence (12.3%). We also identified a mixed trajectory group that had a long first treatment or two treatment episodes with a brief time between treatments: Long first treatment, or immediate recurrence (6.3%), and three recurrent treatment trajectory groups: Recurrent and decreasing (14.2%), Early discontinuation with recurrence (9.9%) and Recurrent after long between treatments period (5.7%). Inpatient or outpatient high intensity (vs. outpatient low intensity) at first entry increased the odds of being in the longer one‐episode groups compared with the Early discontinuation group. Women had increased odds of belonging to all the recurrent groups. Using cocaine paste (vs. alcohol) as a primary substance decreased the odds of belonging to long one‐episode groups.ConclusionsIn Chile, people in publicly funded treatment for substance use disorder show seven distinct care trajectories: three groups with different treatment lengths and no recurring episodes, a mixed group with a long first treatment or two treatment episodes with a short between‐treatment‐episodes period and three recurrent treatment groups.

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“…Access to HIV and viral hepatitis services for people who inject drugs has stagnated, despite their vulnerability to HIV and viral hepatitis being well recognised. This vulnerability has provoked repeated calls for increased access to HIV and viral hepatitis prevention services, including harm reduction interventions, most of which seem to have gone unheeded according to new research published in The Lancet March 2023 by Degenhardt et al [1] and College-Frisby et al [2].…”

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confidence: 99%

New data confirm lack of progress in harm reduction after three decades of proven evidence of effectiveness

et al. 2023

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Epidemiology of injecting drug use, prevalence of injecting-related harm, and exposure to behavioural and environmental risks among people who inject drugs: a systematic review

Cited by 95 publications

References 42 publications

Retention of people who inject drugs enrolled in a ‘medications for opioid use disorder’ (MOUD) programme in Uganda

Retention of people who inject drugs enrolled in a ‘medications for opioid use disorder’ (MOUD) programme in Uganda

Longitudinal trajectories of substance use disorder treatment use: A latent class growth analysis using a national cohort in Chile

New data confirm lack of progress in harm reduction after three decades of proven evidence of effectiveness

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