Heroin Use, HIV-Risk, and Criminal Behavior in Baltimore: Findings from Clinical Research

Schwartz, Robert P.; Kelly, Sharon M.; Gryczynski, Jan; Mitchell, Shannon Gwin; O’Grady, Kevin E.; Jaffe, Jerome H.

doi:10.1080/10550887.2015.1059222

Cited by 4 publications

(3 citation statements)

References 58 publications

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“…Prevalence of prescription opioid misuse and heroin use were also higher in our sample than for Blacks in the general population aged 18-25 (4.6% and 0.1%, respectively). Higher rates of heroin use in this sample is not surprising given that heroin has been endemic in Baltimore City since the 1960s (Agar & Reisinger, 2002;Schwartz et al, 2015). The higher prevalence of prescription opioid misuse is somewhat surprising given evidence of physicians' under prescribing of opioids to Blacks (Burgess et al, 2008).…”

Section: Discussionmentioning

confidence: 73%

Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort

Reboussin

Rabinowitz

Thrul

et al. 2020

Drug and Alcohol Dependence

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Background-Although much of the attention surrounding the opioid epidemic has focused on rural and suburban Whites and prescription opioids, heroin overdoses among urban Blacks are on the rise. While some argue that legalization of cannabis will combat the epidemic, there are concerns it ignores the shift in the epidemic and could increase vulnerability to opioid misuse. The goal of this study is to examine the association between cannabis use from adolescence to young adulthood with opioid misuse in a primarily urban Black cohort.Methods-Data are from a study of 580 youth (85% Black, 67% low SES) residing in Baltimore City followed from ages 626. Cannabis trajectories were identified between ages 14-26 using group-based trajectory modeling. Logistic regressions were conducted to examine the impact of trajectories on opioid misuse in young adulthood adjusting for individual, neighborhood and peer factors. Opioid misuse was defined as using heroin or narcotics or painkillers without a prescription between ages 1926.Results-Four cannabis trajectories were identified: Low/Non-Users (59.7%) Adolescent Onset Limited (19.5%), Young Adult Onset (10.8%), and Adolescent Onset Chronic (10.0%). Adolescent Onset Chronic cannabis users had the highest rate of opioid misuse (44.8%) followed by Adolescent Onset Limited (18.8%), Young Adult Onset (14.8%) and Low/Non-Users (8.3%). Prevalences were significantly higher for Adolescent Onset group relative to Low/Non-Users even after adjustment for neighborhood factors.

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Section: Discussionmentioning

confidence: 73%

Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort

Reboussin

Rabinowitz

Thrul

et al. 2020

Drug and Alcohol Dependence

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“…These “former injectors” can maintain heroin/cocaine use for long periods of time—often decades—without relapsing back to injecting (Des Jarlais et al, 2007). They do as well in methadone treatment as persons who inject (Schwartz et al, 2015) and they are less likely to acquire HCV than persons who continue to inject (Des Jarlais et al, 2013). …”

Section: Introductionmentioning

confidence: 99%

From Long-Term Injecting to Long-Term Non-Injecting Heroin and Cocaine Use: The Persistence of Changed Drug Habits

Jarlais

Arasteh

Feelemyer

et al. 2016

Journal of Substance Abuse Treatment

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Objectives Transitioning from injecting to non-injecting routes of drug administration can provide important individual and community health benefits. We assessed characteristics of persons who had ceased injecting while continuing to use heroin and/or cocaine in New York City. Methods We recruited subjects entering Mount Sinai Beth Israel detoxification and methadone maintenance programs between 2011 and 2015. Demographic information, drug use histories, sexual behaviors, and “reverse transitions” from injecting to non-injecting drug use were assessed in structured face-to-face interviews. There were 303 “former injectors,” operationally defined as persons who had injected at some time in their lives, but had not injected in at least the previous 6 months. Serum samples were collected for HIV and HCV testing. Results Former injectors were 81% male, 19% female, 17% White, 43% African-American, 38% Latino/a, with a mean age of 50 (SD=9.2), and were currently using heroin and/or cocaine. They had injected drugs for a mean of 14 (SD=12.2) years before ceasing injection, and a mean of 13 (SD=12) years had elapsed since their last injection. HIV prevalence among the sample was 13% and HCV prevalence was 66%. The former injectors reported a wide variety of reasons for ceasing injecting. Half of the group appeared to have reached a point where relapse back to injecting was no longer problematic: they had not injected for three or more years, were not deliberately using specific techniques to avoid relapse to injecting, and were not worried about relapsing to injecting. Conclusions Former injectors report very-long term behavior change towards reduced individual and societal harm while continuing to use heroin and cocaine. The behavior change appears to be self-sustaining, with full replacement of an injecting route of drug administration by a non-injecting route of administration. Additional research on the process of long-term cessation of injecting should be conducted within a “combined prevention and care” approach to HIV and HCV infection among persons who use drugs.

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“…We are not aware of historical research on the persistence of drug use hotspots in other cities but believe that persistent hotspots do exist, for instance around central train stations in European cities, e.g., in Amsterdam [33] and in ethnic minority neighborhoods such as Baltimore, Chicago, Los Angeles, Philadelphia, and Washington DC [34, 35] and neighbors with many transient residents (Downtown Eastside in Vancouver, [36]). It is likely that there are many factors that contribute to the persistence of drug use hotspots, including poverty, stigmatization of minority groups, convenient transportation, and anonymity, but we do not yet have an in-depth understanding of the interplay among such factors.…”

Section: Discussionmentioning

confidence: 99%

Geographic distribution of risk (“Hotspots”) for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history

et al. 2019

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Aims To identify geographic “hotspots” for potential transmission of HIV and HCV and for drug overdose among persons who use heroin and cocaine in New York City and to examine historical continuities in problem drug use hotspots in the city. Methods A total of 2714 study participants were recruited among persons entering Beth Israel substance use treatment programs. A structured questionnaire was administered and blood samples for HIV and HCV testing were collected. Hotspots for potential virus transmission were defined as ZIP codes with 10+ participants, 2+ persons infected with the virus and engaging in transmission behavior, and 2+ persons not infected and engaging in acquisition behavior. ZIP codes with 3+ persons with previous overdoses were considered potential hotspots for future overdoses. Results Participants resided in 166/178 (93%) of the ZIP codes in New York City. Injecting drug use was reported in 150/178 (84%) of the ZIP codes. No zip codes were identified for injecting-related HIV transmission, 5 zip codes were identified for sexual HIV transmission, 3 for HCV transmission, and 8 for drug overdose. Many of the ZIP code potential hotspots were in neighborhoods long associated with drug use: Lower Eastside and Harlem in Manhattan, the South Bronx, and Central Brooklyn. Discussion Heroin and cocaine use requiring treatment were reported from almost all ZIP codes in New York City, indicating needs for widely dispersed harm reduction services. Identified hotspots should be targeted for reducing sexual transmission of HIV, transmission of HCV, and drug overdoses. Some of the hotspots have persisted as problem drug use areas for 40 to over 100 years. Monitoring of drug use patterns in historical hotspot neighborhoods may permit early identification of and response to emerging drug use-related health problems. Persistent historical hotspots for problem drug use present a complex problem for implementing harm reduction services that deserve additional research.

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Heroin Use, HIV-Risk, and Criminal Behavior in Baltimore: Findings from Clinical Research

Cited by 4 publications

References 58 publications

Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort

Trajectories of cannabis use and risk for opioid misuse in a young adult urban cohort

From Long-Term Injecting to Long-Term Non-Injecting Heroin and Cocaine Use: The Persistence of Changed Drug Habits

Geographic distribution of risk (“Hotspots”) for HIV, HCV, and drug overdose among persons who use drugs in New York City: the importance of local history

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