The rising prevalence of prescription opioid injection and its association with hepatitis C incidence among street‐drug users

Addiction - Tập 107 Số 7 - Trang 1318-1327 - 2012
Julie Bruneau1,2, Élise Roy3,4, Nelson Arruda5, Geng Zang2, Didier Jutras‐Aswad6,2
1Department of Family Medicine, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
2Research Center, Centre Hospitalier de l'Université de Montréal (CRCHUM), Montréal, Québec, Canada
3Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Longueuil, Québec, Canada
4Montreal Public Health Department, Agence de la santé et des services sociaux de Montréal, Montréal, Québec, Canada
5Independent Investigator and Consultant, Montréal, Québec, Canada
6Department of Psychiatry, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada

Tóm tắt

ABSTRACTAims  To examine trends in prescription opioid (PO) injection and to assess its association with hepatitis C virus (HCV) seroconversion among injection drug users (IDUs).Design  Prospective cohort study.Setting  Montreal, Canada.Participants  HCV‐negative IDUs at baseline, reporting injection in the past month.Measurements  Semi‐annual visits included HCV antibody testing and an interview‐administered questionnaire assessing risk behaviours. HCV incidence rate was calculated using the person–time method. Time‐updated Cox regression models were conducted to examine predictors of HCV incidence.Findings  The proportion of IDUs reporting PO injection increased from 21% to 75% between 2004 and 2009 (P < 0.001). Of the 246 participants (81.6% male; mean age 34.5 years; mean follow‐up time 23 months), 83 seroconverted to HCV [incidence rate: 17.9 per 100 person‐years; 95% confidence interval (CI) 14.3, 22.1]. Compared to non‐PO injectors, PO injectors were more likely to become infected [adjusted hazard ratio (AHR): 1.87; 95%CI:1.16, 3.03]. An effect modification was also found: PO injectors who did not inject heroin were more likely to become infected (AHR: 2.88; 95%CI: 1.52, 5.45) whereas no association was found for participants using both drugs (AHR: 1.19; 95% CI: 0.61, 2.30). Other independent predictors of HCV incidence were: cocaine injection, recent incarceration and >30 injections per month.Conclusions  Prescription opioid injectors who do not inject heroin are at greater risk for HCV seroconversion than are those injecting both heroin and prescription opioids. Important differences in age, behaviour and social context suggest a need for targeted outreach strategies to this population.

Từ khóa


Tài liệu tham khảo

International Narcotics Control Board.Report of the International Narcotics Control Board for 2010. United Nations Publication.2011. Available at:http://www.incb.org/incb/en/annual‐report‐2010.html(accessed 8 July 2011; archived by WebCite® athttp://www.webcitation.org/601fkPN1C).

Substance Abuse and Mental Health Administration (SAMHSA) US Department of Health and Human Services Office of Applied Studies.Drug Abuse Warning Network 2006: national estimates of drug‐related emergency department visits.2008. Available at:http://DAWNinfo.samhsa.gov(accessed 8 July 2011; archived by WebCite® athttp://www.webcitation.org/601fq4hLO).

10.1186/1747-597X-6-11

Drug and Alcohol Treatment Information System (DATIS) Centre for Addiction and Mental Health.Substance abuse statistical tables.2010. Available at:http://www.datis.ca/pub/reports/DATIS%20SA%20Statistical%20Tables%200910.pdf(accessed 8 July 2011; archived by WebCite® athttp://www.webcitation.org/601ftdukS).

10.1016/j.drugalcdep.2007.08.008

10.5055/jom.2006.0042

10.1503/cmaj.060729

10.1016/j.drugalcdep.2006.08.029

10.1080/09595230600868504

10.1080/00952990601175078

ParentR. AlaryM. MorissetteC. RoyE. LeclercP. AllardP. R.Surveillance des maladies infectieuses chez les utilisateurs de drogue par injection—Épidémiologie du VIH de 1995 à 2008—Épidémiologie du VHC de 2003 à 2008[Surveillance of infectious diseases among injection drug users‐Epidemiology of HIV from 1995 to 2008‐Epidemiology of HCV from 2003 to 2008.]. Institut National de Santé Publique du Québec.2009. Available at:http://www.inspq.qc.ca/publications/notice.asp?E=p&NumPublication=1021(accessed 8 July 2011; archived by WebCite® athttp://www.webcitation.org/601fyJimc).

10.1111/j.1465-3362.2011.00299.x

10.2174/138161208784746770

Wasley A., 2008, Surveillance for acute viral hepatitis—United States, 2006, MMWR Surveill Summ, 57, 1

10.1080/00365540500525161

10.1016/j.drugalcdep.2007.05.026

10.3748/wjg.v13.i17.2436

10.1097/00002030-200304110-00014

10.1053/jhep.2002.35065

10.1016/j.drugpo.2010.05.001

10.1258/095646207779949880

10.1007/BF03404324

Craib K. J., 2009, Prevalence and incidence of hepatitis C virus infection among Aboriginal young people who use drugs: results from the Cedar Project, Open Med, 3, e220

10.1111/j.1365-2893.2007.00942.x

10.1086/649783

10.1093/aje/155.7.645

Koester S. K., 1994, The context of risk: ethnographic contributions to the study of drug use and HIV, NIDA Res Monogr, 143, 202

10.3109/10826084.2011.552932

Bruneau J., 2001, Sex‐specific determinants of HIV infection among injection drug users in Montreal, Can Med Assoc J, 164, 767

10.1136/jech.2007.064154

10.1007/978-1-4757-2728-9

Hosmer D. J., 1999, Applied Survival Analysis: Regression Modeling of Time to Event Data, 386

10.1016/j.drugalcdep.2009.01.006

Patrick D. M., 2001, Incidence of hepatitis C virus infection among injection drug users during an outbreak of HIV infection, Can Med Assoc J, 165, 889

10.1097/01.ede.0000135170.54913.9d

10.1016/j.drugpo.2009.02.007

10.1016/j.drugalcdep.2007.01.001

Wood E., 2003, Impact of supply‐side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure, Can Med Assoc J, 168, 165

10.1016/S0376-8716(03)00013-9

10.2105/AJPH.91.1.42

10.1086/345554

Mehta S. H., 2010, Epidemiology of hepatitis C virus infection and liver disease among injection drug users (IDUs) in Chennai, India, Indian J Med Res, 132, 706

10.3109/10826089809056260

10.1525/9780520943315

10.1086/504327

10.1046/j.1360-0443.1998.939141712.x

10.1111/j.1365-2893.2005.00643.x

10.1093/ije/dyh019

10.1080/00365540050165875

Brunton C., 2000, Cumulative incidence of hepatitis C seroconversion in a cohort of seronegative injecting drug users, NZ Med J, 113, 98

10.1093/aje/kwq479

10.1080/01459740.2000.9966161

Comité permanent de lutte à la toxicomanie Ministère de la santé et des services sociaux (MSSS).Le point sur la situation de la toxicomanie au Québec en l'an 2000[Drug addiction Update in Quebec in the year 2000.]. MSSS Québec.2000. Available at:http://publications.msss.gouv.qc.ca/biblio/CPLT/publications/0900pt.pdf(accessed 8 July 2011; archived by WebCite® athttp://www.webcitation.org/601g5vrs4).

10.1093/oxfordjournals.aje.a008806

Thông tin
Thông tin xuất bản

Addiction

Tập 107 Số 7

1318-1327

Thông tin tác giả