Ifeoma N. Onyeka

Sociodemographic Characteristics and Drug Abuse Patterns of Treatment-Seeking Illicit Drug Abusers in Finland, 1997–2008: The Huuti Study

The epidemiological part of the Huume tietokanta (HUUTI) consortium research project is the first large-scale longitudinal study of treatment-seeking illicit drug abusers in Finland. The objective of this report was to describe the sociodemographic characteristics and drug abuse patterns of treatment-seeking clients at their first visit. This study analysed baseline data of 4817 clients (3365 men and 1452 women) aged 11–65 years who sought treatment for drug abuse between 1997 and 2008 at Helsinki Deaconess Institute. Data were collected using a structured questionnaire. The majority (56%) of clients were between 15 and 24 years, educated at elementary school level (75%), and unemployed (57%). Opiates (30%) were the primary drugs of abuse. The primary drugs were mostly injected (45%) and were abused daily during the past month (44%). Cannabis was the most common secondary drug of abuse (34%). The secondary drugs were predominantly smoked (39%) or taken orally (38%) and were abused once per week or less frequently during the past month (33%). Age at initiation of illicit drug abuse ranged from 5 to 49 years. Polydrug abuse was common, with a mean consumption of 3.5 concurrent polydrug use, which were combined from 3 or more drug classes. The prevalence of lifetime/ever intravenous drug abuse was 64% and past month intravenous drug abuse was 64%, respectively, and 13% reported sharing injecting equipment during the past month. Early initiation, polydrug abuse, and risky consumption of illicit drugs were major areas of concern among the study population. Injecting drug use could place considerable burden on health services in view of complications and transmission of infectious diseases.

Twelve-year trend in treatment seeking for buprenorphine abuse in Finland

BACKGROUND Buprenorphine abuse is becoming increasingly common worldwide. However, large-scale long-term studies of buprenorphine abuse are lacking. The objective of this study was to examine the trend in characteristics of clients seeking treatment for buprenorphine abuse and compare them to those seeking treatment for heroin and amphetamine abuse. METHODS A 12-year descriptive study was conducted at the Helsinki Deaconess Institute (HDI), a public utility foundation responsible for providing treatment for substance abuse in the greater Helsinki area. All clients seeking treatment between 31 January 1997 and 31 August 2008 received a structured clinical interview concerning demographic characteristics and abuse patterns. Characteristics of clients who reported that their primary drug of abuse was buprenorphine (n=780) were compared to those whose primary drug of abuse was either heroin (n=598) or amphetamine (n=1249). RESULTS The annual proportion of buprenorphine clients increased from 3.0% in 1998 to 38.4% in 2008. Daily abuse (73.8%) and intravenous administration (80.6%) were common among buprenorphine clients. Concurrent abuse of prescription medications (p<0.001), stimulants (p=0.001) and alcohol (p<0.001) increased from 1997 to 2008. Treatment seeking for heroin abuse declined to approximately 1% of clients annually after 2002. Buprenorphine clients were more likely to be daily users of their primary drug (p<0.001), abuse prescription medications (p<0.001) and administer drugs intravenously (p=0.001 from 1997 to 2001) compared to heroin and amphetamine clients. CONCLUSIONS Our results highlight the increasing abuse of buprenorphine in Finland. Buprenorphine clients had risky abuse patterns in terms of daily use and intravenous administration. Concurrent substance abuse increased during the study period.

Coexisting social conditions and health problems among clients seeking treatment for illicit drug use in Finland: The HUUTI study

BackgroundIllicit drug use is an important public health problem. Identifying conditions that coexist with illicit drug use is necessary for planning health services. This study described the prevalence and factors associated with social and health problems among clients seeking treatment for illicit drug use.MethodsWe carried out cross-sectional analyses of baseline data of 2526 clients who sought treatment for illicit drug use at Helsinki Deaconess Institute between 2001 and 2008. At the clients’ first visit, trained clinicians conducted face-to-face interviews using a structured questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for factors associated with social and health problems.ResultsThe mean age of the clients was 25 years, 21% (n = 519) were homeless, 54% (n = 1363) were unemployed and 7% (n = 183) had experienced threats of violence. Half of the clients (50%, n = 1258) were self-referred and 31% (n = 788) used opiates as their primary drugs of abuse. Hepatitis C (25%, n = 630) was more prevalent than other infectious diseases and depressive symptoms (59%, n = 1490) were the most prevalent psychological problems. Clients who were self-referred to treatment were most likely than others to report social problems (AOR = 1.86; 95% CI = 1.50–2.30) and psychological problems (AOR = 1.51; 95% CI = 1.23–1.85). Using opiates as primary drugs of abuse was the strongest factor associated with infectious diseases (AOR = 3.89; 95% CI = 1.32–11.46) and for reporting a combination of social and health problems (AOR = 3.24; 95% CI = 1.58–6.65).ConclusionThe existence of illicit drug use with other social and health problems could lead to increased utilisation and cost of healthcare services. Coexisting social and health problems may interfere with clients’ treatment response. Our findings support the call for integration of relevant social, medical and mental health support services within drug treatment programmes.

Hepatitis C as a risk factor for carotid atherosclerosis - a systematic review.

Observational studies on the association of chronic hepatitis C with carotid atherosclerosis have yielded varying results. In addition, previous related systematic reviews were limited in synthesis. By more careful selection and further synthesis, we summarize current body of evidence on the relationship between chronic hepatitis C and carotid atherosclerosis.

Mortality among clients seeking treatment for buprenorphine abuse in Finland

BACKGROUND It is unclear whether buprenorphine abuse is associated with a similar risk of death to other substance abuse. This study examined all-cause mortality rates and causes of deaths among clients seeking treatment for buprenorphine abuse. METHODS Structured clinical interviews were conducted with 4685 clients between January 1998 and August 2008. Records of deaths that occurred among these clients were extracted from the Official Causes of Death Register in Finland. Standardized mortality ratios (SMRs) with 95% confidence intervals (CI) were computed using national mortality rates over a 13-year follow-up to examine excess mortality. Kaplan-Meier survival analysis was used to compare survival between buprenorphine and other clients. RESULTS Sixty-one of 780 (7.8%) clients who sought treatment for buprenorphine abuse and 408 of 3905 (10.4%) other clients died during the 13-year follow-up period. The most common cause of death was drug-related in buprenorphine (n=25, 41.0%) and other clients (n=142, 34.8%). Survival rates were similar among buprenorphine and other clients (log-rank χ[df=1](2)=0.215, p=0.643). The SMR was 3.0 (95% CI 2.3-3.8) and 3.1 (95% CI 2.8-3.4) for buprenorphine and other clients, respectively. Excess mortality was highest among women aged 20-29 years, and more pronounced in buprenorphine clients (SMR 27.9 [95% CI 12.6-49.0]) compared to other clients (SMR 14.0 [95% CI 9.3-19.6]). CONCLUSIONS Clients seeking treatment for buprenorphine abuse had a three times higher mortality rate than the national average, with the excess risk highest among female clients. Overall mortality rates were similar among clients seeking treatment for buprenorphine and other substance abuse.

Hospitalization in a Cohort Seeking Treatment for Illicit Drug Use in Finland

Illicit drug use is associated with various health problems that result in inpatient hospital admissions. The primary objective of this study was to examine all-cause and cause-specific hospitalizations by gender. The cohort comprised 4817 drug users (3365 males and 1452 females) who sought treatment in Helsinki between 1997 and 2008. Data on hospitalizations that occurred among these clients were extracted from the National Hospital Discharge Register. Crude hospitalization rates (CHRs) and standardized hospitalization ratios (SHRs) with 95% confidence intervals (CIs) were calculated, and Kaplan-Meier analysis with Log-Rank test was used to compare survival in terms of time to hospitalization between males and females. At the end of the follow-up period, 84.5% of females and 73.3% of male clients were hospitalized at least once. Female clients had higher CHR (607.6/1000 person-years, 95%CI: 594.1-621.4) than males (511.0/1000, 95% CI: 502.9-519.3), and had significantly poorer survival than males (Log-Rank test, P<0.001). However, male clients stayed longer on admission than females (mean length of stay 70.2days versus 60.7days respectively, P<0.001). Compared to the national rates, excess hospitalizations were noted in both males (SHR=6.3, 95% CI: 6.2-6.4) and female clients (SHR=4.3, 95% CI: 4.2-4.4). Based upon primary discharge diagnosis, the leading causes of hospitalizations included psychosis (n=622), schizophrenia (n=604), depression (n=497), cardiovascular diseases (n=223), hepatitis C (n=116), HIV (n=81), and other types of hepatitis (n=45). Female clients were more likely than males to be admitted for hepatitis C infection (P<0.001) and depression (P<0.001). Male clients were more likely than females to be diagnosed with other types of hepatitis infections (P=0.032) and psychosis (P=0.035). Excess hospitalizations signify excessive utilization of health resources. Effective drug abuse treatment, gender-sensitive approaches, and regular health checks can help to reduce morbidity. Appropriate measures are needed to address psychiatric problems in this population.

Patterns and 14-year trends in mortality among illicit drug users in Finland: The HUUTI study

BACKGROUND Although mortality is a known complication of illicit drug use, robust epidemiological studies on drug-related mortality in Finland are scarce. We examined all deaths, specific causes of death, and trends in mortality among a large number of illicit drug users in Finland during a 14-year period. METHODS Details of 4817 clients who sought treatment for drug use at Helsinki Deaconess Institute between 1997 and 2008 were linked to national cause of death register to identify all deaths and causes of death. Standardised mortality ratios (SMRs) were calculated to compare all-cause deaths in our study cohort with those in the general population. Trends in mortality rates were assessed using Poisson (log-linear) regression. RESULTS A total of 496 deaths occurred during 41,567.5 person-years with crude mortality rate of 1193.2 per 100,000 person-years. Mean follow-up was 8.6 years and the mean age at death was 33.8 years. Most deaths (84.1%) occurred among male clients, 189 deaths occurred in the 25-34 age-group and all-cause SMR was 8.9 [95% confidence interval (CI)=8.1-9.7]. Two-thirds (64.9%) were deaths from external causes and 35.1% from disease-related causes. The four leading causes of death were accidental poisoning/overdose (n=165), suicide (n=108), mental and behavioural disorders (n=49) and circulatory system diseases (n=45). Younger clients died from acute effects of drug use while older clients died more from chronic health conditions. A decline in annual rates was noted for all-cause mortality (P=0.01), deaths from mental and behavioural disorders (P<0.001) and suicides (P<0.001). CONCLUSION The four leading causes of death among illicit drug users are preventable. Overdose management training, drug education and other preventive measures could help reduce mortality.

Characteristics of drug-abusing females with and without children seeking treatment in Helsinki, Finland

Aims: This study characterizes treatment-seeking female users of illicit drugs in Finland, and examines possible differences among women with or without children under 18. Methods: The subjects were 2526 drug-using clients from the Helsinki metropolitan area, who sought treatment at Helsinki Deaconess Institute between 2001 and 2008. A total of 775 (30.6%) were females with complete information regarding their parental status. Of these, 225 (29%) had children under 18. The proportion of women with children varied between 20% and 30% annually, except in 2006, when it peaked at 40.5%. Results: Women with children were more likely to be somewhat older (p<0.001), married or cohabiting (p<0.001), homeless (p=0.007), unemployed (p<0.001), and living with other illicit drug users (p=0.014), compared with those without children. Self-referral and referral to treatment by child healthcare services were more common among those who had children (p<0.001). A higher proportion of women with children reported use of opiates as the primary drug (p<0.001), and used them more often intravenously (p=0.001), and daily (p=0.007), during the previous month. However, polydrug use (p=0.607) and sharing of needles/syringes (p=0.945) were similar in both groups. Prevalence of hepatitis B and C (p=0.041 and p<0.001, respectively) were more common in females with children. Among women who had children, 34.2% had children living within the same household, 37.3% in foster care, and 22.7% elsewhere. Conclusions: Women with children had more risky drug consumption patterns, and were more likely to live with other drug users; this creates an unhealthy environment for child rearing.

Association between routes of drug administration and all-cause mortality among drug users

Abstract Mortality among drug users based upon routes of administration (ROA) is less studied. We examined deaths by ROA, and association between ROA and all-cause deaths. Data of 2766 primary users of opiates and stimulants who sought treatment in Helsinki, Finland, from 1997 to 2008 were linked to the national cause-of-death register. Cox regression models were used to compute adjusted hazard ratios (aHRs) for all-cause deaths, with 95% confidence intervals (CIs). There were statistically significant differences in all-cause deaths by ROA reported at baseline interview (p = 0.012): 12.7% (n = 251/1976) among intravenous (IV) drug users, 11.5% (n = 27/235) among oral users, 7.9% (n = 12/152) among smokers, 6.9% (n = 19/276) among snorters, and 16.5% (n = 21/127) among those with unspecified ROA. IV users died more from accidental overdose relative to other specified routes (p = 0.036). All nine HIV and all three hepatitis C deaths occurred among IV users. The hazard for all-cause death was lower among smokers compared to IV users (aHR: 0.52 (95%CI: 0.28–0.97) after adjusting for gender, homelessness, drug use behaviours, and psychiatric comorbidities present at baseline. Deaths occurred in all groups: drug users in general need to be educated that no route of drug administration is harmless. Preventive and intervention measures should target all ROA.

Changes in breastfeeding and nutritional status of Nigerian children between 1990 and 2008, and variations by region, area of residence and maternal education and occupation

Background:Inadequate breastfeeding practices contribute to malnutrition in young children. Aims and objectives:This study examined changes in breastfeeding practices and the nutritional status of children (0–35 months, n = 37154) using data from the nationally-representative Nigerian Demographic and Health Surveys for 1990–2008. Methods:The study estimated the relative changes in the proportion of children meeting recommended breastfeeding practices and the anthropometric indices of the children during the study period, by region, place of residence, maternal education and maternal occupation. Results:In each study year, over 97% of the children were ever breastfed. The proportion of infants breastfed within 1 hour and 1 day of birth increased from 34% to 45.8%, and from 63.8% to 82.3%, respectively. Overall, breastfeeding for ≥ 12 months changed from 88.9% to 95.2%, an increase of 7%; however, an increase of 14% was observed in the northern region (from 86.1% to 97.8%) while a decline of 7% was observed in the southern region (from 97.1% to 89.9%). Over the study period, the prevalence of all the assessed indicators of malnutrition (stunting, wasting and underweight) increased in the northern region while the southern region experienced a decline in all except severe wasting. In both urban and rural areas, stunting and wasting increased, while underweight declined. Children of non-formally educated and unemployed mothers were more malnourished in all the study years. Conclusion:Improvement in some breastfeeding practices did not result in improvement in the nutritional status of Nigerian children during 1990–2008, particularly in northern Nigeria and among socially disadvantaged mothers. Improving maternal education and employment, and integrating messages on techniques and benefits of optimal infant feeding with other maternal and child healthcare services could be beneficial.