Trajectories of initiation for the heroin-based drug whoonga – qualitative evidence from South Africa

Tyree, Griffin A.; Mosery, Nzwakie; Closson, Elizabeth F.; Mabude, Zonke; Toit, Carol du; Bangsberg, David R.; Safren, Steven A.; Mayer, Kenneth H.; Smit, Jennifer; Mimiaga, Matthew J.; Grelotti, David J.

doi:10.1016/j.drugpo.2020.102799

Cited by 12 publications

(20 citation statements)

References 30 publications

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“…compared with these laboratory approaches. There is even some indication that inhalation use of heroin may come before a switch to injection use (Clatts et al, 2011;Cui et al, 2015;Rahimi-Movaghar et al, 2015;Syvertsen et al, 2017;Tyree et al, 2020), perhaps due to perceptions of safety or cultural factors. This may be true with respect to, e.g., disease transmission associated with intravenous injection practices but may involve other risks.…”

Section: Introductionmentioning

confidence: 99%

A vapor exposure method for delivering heroin alters nociception, body temperature and spontaneous activity in female and male rats

Gutierrez

Creehan

Taffe

2021

Journal of Neuroscience Methods

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Background:The ongoing crisis related to non-medical use of opioids makes it of continued importance to understand the risk factors for opioid addiction, the behavioral and neurobiological consequences of opioid exposure and to seek potential avenues for therapy.Pre-clinical rodent models have been critical to advancing understanding of opioid consequences for decades, but have been mostly limited to drug delivery by injection or by oral dosing. Inhalation, a significant route for many human users, has not been as well-established. Method:We adapted an e-cigarette based exposure system, previously shown efficacious for delivery of other drugs to rats, to deliver heroin vapor. Effects in vivo were assessed in male and female Sprague-Dawley rats using a warm-water assay for anti-nociception and an implanted radiotelemetry system for evaluating changes in body temperature and spontaneous activity rate.Results: Inhalation of vapor created by heroin 100 mg/mL in the propylene glycol (PG) vehicle significantly slowed tail-withdrawal from a 52°C water bath, bi-phasically altered activity, and increased temperature in male and female rats. Inhalation of heroin 50 mg/mL for 15 minutes produced significant effects, as the lower bound on efficacy, whereas inhalation of heroin 100 mg/mL for 30 minutes produced robust effects across all endpoints and groups. Conclusions:This work shows that e-cigarette devices deliver psychoactive doses of heroin to rats, using concentrations of ~50-100 mg/mL and inhalation durations of 15-30 minutes. This technique may be useful to assess the health consequences of inhaled heroin and other opioid drugs.

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Section: Introductionmentioning

confidence: 99%

A vapor exposure method for delivering heroin alters nociception, body temperature and spontaneous activity in female and male rats

Gutierrez

Creehan

Taffe

2021

Journal of Neuroscience Methods

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“…Entrenched health inequalities reflect and exacerbate wider social problems. The synergistic nature of HIV and substance abuse is well-documented [13][14][15] and alcohol and substance abuse is recognised as a serious, growing problem in the country [16]. Treatment demand for heroin-related problems is high in Mpumalanga, the rural province where the research was based [17].…”

Section: Introductionmentioning

confidence: 99%

“…Over the past decade, Nyaope has emerged as a low-grade heroin smoked with marijuana, benzene, glue, and antiretrovirals (ARVs), used widely in rural areas. Whoonga is a distinct heroin-based street drug, made with household cleaning products, rat poison, and ARVs to which youth are seen as especially vulnerable [16]. There are limited resources allocated to the issue: low capacity, poor infrastructure, lack of information and poor intersectoral collaboration [24].…”

Section: Introductionmentioning

confidence: 99%

‘Voice needs teeth to have bite’! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa

D’Ambruoso

Mabetha²,

Twine³

et al. 2022

PLOS Glob Public Health

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There is limited operational understanding of multisectoral action in health inclusive of communities as active change agents. The objectives were to: (a) develop community-led action-learning, advancing multisectoral responses for local public health problems; and (b) derive transferrable learning. Participants representing communities, government departments and non-governmental organisations in a rural district in South Africa co-designed the process. Participants identified and problematised local health concerns, coproduced and collectively analysed data, developed and implemented local action, and reflected on and refined the process. Project data were analysed to understand how to expand community-led action across sectors. Community actors identified alcohol and other drug (AOD) abuse as a major problem locally, and generated evidence depicting a self-sustaining problem, destructive of communities and disproportionately affecting children and young people. Community and government actors then developed action plans to rebuild community control over AOD harms. Implementation underscored community commitment, but also revealed organisational challenges and highlighted the importance of coordination with government reforms. While the action plan was only partially achieved, new relationships and collective capabilities were built, and the process was recommended for integration into district health planning and review. We created spaces engaging otherwise disconnected stakeholders to build dialogue, evidence, and action. Engagement needed time, space, and a sensitive, inclusive approach. Regular engagement helped develop collaborative mindsets. Credible, actionable information supported engagement. Collectively reflecting on and adapting the process supported aligning to local systems priorities and enabled uptake. The process made gains raising community ‘voice’ and initiating dialogue with the authorities, giving the voice ‘teeth’. Achieving ‘bite’, however, requires longer-term engagement, formal and sustained connections to the system. Sustaining in highly fluid contexts and connecting to higher levels are likely to be challenging. Regular learning spaces can support development of collaborative

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“…Slightly more than two-thirds came from Africa and almost half originated from East Africa. In recent years, continental Africa – and particularly so select countries such as Tanzania (Tiberio et al , 2018) – and South Africa have evolved as a central source and transit region for global heroin trafficking routes, while use has proliferated in other countries (Affinnih, 2002; Harker et al , 2020; Trumbore and Woo, 2014; Tyree et al , 2020; Wyler and Cook, 2009). Select sub-groups have been associated with the trafficking and distribution of specific drug types, including heroin, e.g.…”

Section: Discussionmentioning

confidence: 99%

Examining a migration-based phenomenon of heroin use in an urban drug scene in Sao Paulo, Brazil

Ribeiro

Frajzinger²,

Perrenoud³

et al. 2021

IJMHSC

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Purpose Brazil’s street-based drug use is mostly characterized by non-injection psychostimulant (e.g. crack-cocaine) drug use in Brazil, with limited interventions and service availability. Recently, an influx of multi-ethnic migrants within an urban drug scene in Sao Paulo was associated with heroin use, a drug normatively absent from Brazil. The purpose of this paper is to characterize and compare heroin use-related characteristics and outcomes for an attending sub-sample of clients from a large community-based treatment centre (“CRATOD”) serving Sao Paulo’s local urban drug scene. Design/methodology/approach All non-Brazilian patients (n = 109) receiving services at CRATOD for 2013–2016 were identified from patient files, divided into heroin users (n = 40) and non-heroin users (n = 69). Based on chart reviews, select socio-demographic, drug use and health status (including blood-borne-virus and other infections per rapid test methods) were examined and bi-variately compared. Multi-variate analyses examined factors independently associated with heroin use. Findings Most participants were male and middle-aged, poly-drug users and socio-economically marginalized. While heroin users primarily originated from Africa, they reported significantly more criminal histories, drug (e.g. injection) and sex-risk behaviors and elevated rates of BBV (e.g. Hepatitis C Virus and HIV). A minority of heroin users attending the clinic was provided methadone treatment, mostly for detoxification. Originality/value This study documented information on a distinct sample of mostly migration-based heroin users in Sao Paulo, Brazil. Based on the local experience, global migration dynamics can bring changes to established drug use cultures and services, including new challenges for drug use-related related behaviors and therapeutic interventions that require effective understanding and addressing.

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Trajectories of initiation for the heroin-based drug whoonga – qualitative evidence from South Africa

Cited by 12 publications

References 30 publications

A vapor exposure method for delivering heroin alters nociception, body temperature and spontaneous activity in female and male rats

A vapor exposure method for delivering heroin alters nociception, body temperature and spontaneous activity in female and male rats

‘Voice needs teeth to have bite’! Expanding community-led multisectoral action-learning to address alcohol and drug abuse in rural South Africa

Examining a migration-based phenomenon of heroin use in an urban drug scene in Sao Paulo, Brazil

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