High hepatitis C incidence in relation to prescription opioid injection and poly-drug use: Assessing barriers to hepatitis C prevention

Puzhko, Svetlana; Roy, Élise; Jutras‐Aswad, Didier; Artenie, Andreea Adelina; Fortier, Emmanuel; Zang, Geng; Bruneau, Julie

doi:10.1016/j.drugpo.2017.05.027

Cited by 26 publications

(22 citation statements)

References 49 publications

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“…Consequently, the possibility of concurrent use of other substances should always be taken into consideration, even when only the use of one particular psychotropic substance is the focus of a study (57). For example, while polydrug use is often considered a barrier in the prevention of hepatitis C virus (HCV) transmission in individuals who inject prescription opioids, research on the underlying mechanisms is relatively sparse (166).…”

Section: Discussionmentioning

confidence: 99%

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

Hiebler‐Ragger

Unterrainer

2019

Front. Psychiatry

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Background: Substance use disorders (SUDs) represent a worldwide epidemic with extensive costs to the individual and to society. Occasionally described as an attachment disorder, they have been linked to various impairments in self-regulation and social functioning. However, while there have been significant advances in the development and validation of treatment strategies for SUD in recent years, the components of these treatment approaches have yet to be fully explored. The characteristics of polydrug use disorder (PUD) especially need to be addressed in more detail, as this diagnosis is highly common in individuals seeking treatment, while simultaneously being associated with poor treatment success. Aim and Scope: This review aims at further exploring the relevance of attachment in PUD and its treatment. To this end, this review provides a concise summary of relevant theories on the development and treatment of SUD in general, including related parameters of attachment, emotion regulation, and neuroscience. Furthermore, several studies focused specifically on PUD are described in more detail. These studies explored the connections between attachment, personality structure, primary and higher emotions (including spirituality), as well as structural and functional neural parameters in inpatients with PUD as well as in healthy controls. Most notably, the described studies highlight that insecure attachment and impairments in personality structure are present in inpatients with PUD. In addition, these characteristics are paralleled by extensive impairments in white matter integrity, especially in tracts connected to facets of emotion regulation. Conclusions: Based on our findings, we emphasize conceptualization of PUD as an Attachment Disorder, on a behavioral as well as on a neural level. Furthermore, we point out the importance of an integrated bio-psycho-social approach in this research area. Consequently, future studies might more closely focus on the influence of attachment-based interventions on emotion regulation abilities as well as a potentially related neuroplasticity. Neuroplastic changes, which are still rather unexplored, might represent important parameters for the assessment of treatment outcomes especially in long-term SUD treatment.

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Section: Discussionmentioning

confidence: 99%

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

Hiebler‐Ragger

Unterrainer

2019

Front. Psychiatry

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“…A cohort study in Canada with injecting drug users found an increased risk of HCV infection among polydrug users, among individuals that used opioid in combination with cocaine/crack. The authors suggested that this increased risk of acquiring HCV results from cocaine’s stimulant effects (whether injected or smoked), which could affect decision-making processes, and which could also contribute to the increased risk of HCV transmission through shared injection paraphernalia 33 . The possible role of the combined use of opioids and stimulants is not clear, since intense, exclusive use of opioids is sometimes associated with sexual dysfunction 34 , as opposed to crack users’ intense, usually unprotected sexual activity, which may or may not be associated with the sexual transmission of HCV.…”

Section: Discussionmentioning

confidence: 99%

The risks of HCV infection among Brazilian crack cocaine users: incorporating diagnostic test uncertainty

Coutinho

Bastos

Mota

et al. 2019

Sci Rep

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Despite the initiative by WHO and other international organizations to eliminate HCV in the medium term, hepatitis C infection is still a major public health problem. Even non-injecting drugs users who engage in harmful or addictive drug use are at greater risk of acquiring the infection, when compared to the general population. This study evaluate risk factors for HCV infection in users of crack/cocaine in Brazil, using multilevel models that incorporate variations in the sensitivity and specificity of the respective diagnostic tests. The sample included all the participants of a national survey on street crack cocaine users with serologically reactive result in the rapid test for the HCV as well as 4 non-reactive controls, matched by sex, age category, and major geographic region of residence. Multilevel logistic regression models were used, with and without incorporation of the diagnostic test’s sensitivity and specificity values. The odds of HCV infection were 85% higher among polydrug users, 7.81 times higher among injecting drug users, and 3.69 times higher in those reporting to have genital ulcers. Statistical modeling strategies that incorporate the sensitivity and specificity of diagnostic tests in challenging settings are useful for studying the association between risk factors and infection status.

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“…[5][6][7] For 2016, the mean rate of apparent opioid-related overdose deaths has reached 7.9 per 100 000 population (i.e., corresponding to a total of 2861 fatalities), with the highest death rates reported for western Canada. 8 This upsurge in opioid-related harms, including overdose deaths, [2][3][4][5][6]8,9 underscores the critical need for coordinated, evidence-based approaches to prevention, treatment and harm reduction to address this national public health emergency.…”

mentioning

confidence: 99%

Management of opioid use disorders: a national clinical practice guideline

Bruneau

Ahamad

Goyer

et al. 2018

CMAJ

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336

392

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High hepatitis C incidence in relation to prescription opioid injection and poly-drug use: Assessing barriers to hepatitis C prevention

Cited by 26 publications

References 49 publications

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

The Role of Attachment in Poly-Drug Use Disorder: An Overview of the Literature, Recent Findings and Clinical Implications

The risks of HCV infection among Brazilian crack cocaine users: incorporating diagnostic test uncertainty

Management of opioid use disorders: a national clinical practice guideline

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