Katherine Rudzinski

Hepatitis C virus transmission among oral crack users: viral detection on crack paraphernalia.

Objective Epidemiological studies present oral crack use as a potential independent risk factor for hepatitis C virus (HCV) status, yet actual HCV transmission pathways via crack use have not been evidenced. To this end, this exploratory study sought to detect HCV on crack-use paraphernalia used by street crack users. Methods Crack-use paraphernalia within 60 min of use was collected from 51 (N) street-crack users. HCV RNA detection was conducted through eluate sampling and manual RNA extraction. Participants provided a saliva sample to test for HCV antibody, and had a digital photograph taken of their oral cavities, to assess the presence of oral sores as a possible risk factor for oral HCV transmission. Results About 43.1% (n=22) of the study participants were HCV-antibody positive. One (2.0%) of the 51 pipes tested positive. A minority of the participants presented oral sores. The pipe on which HCV was detected was made from a glass stem; its owner was HCV-antibody positive, and there was full rater agreement on the presence of oral sores in the pipe owners oral cavity. Conclusions HCV transmission from an infected host onto paraphernalia as a precondition of HCV host-to-host transmission via shared crack paraphernalia use seems possible, with oral sores and paraphernalia condition constituting possible risk modifiers. Larger-scale studies with crack users are needed to corroborate our findings.

Frequent food insecurity among injection drug users: correlates and concerns

BackgroundFood insecurity and nutrition are two topics that are under-researched among injection drug users (IDUs). Our study examined the extent and correlates of food insecurity among a sample of IDUs and explored whether there is an association between food insecurity and injection-related HIV risk.MethodsA cross-sectional survey was conducted using interviewer-administered questionnaires. Data were collected at a needle exchange program in London, Ontario, Canada between September 2006 and January 2007. Participants included 144 English-speaking IDUs who had injected drugs in the past 30 days. Participants were asked about their socio-demographic characteristics, HIV risk behaviours, food insecurity, and health/social service use.ResultsIn the past 6 months, 54.5% of participants reported that on a daily/weekly basis they did not have enough to eat because of a lack of money, while 22.1% reported this type of food insecurity on a monthly basis. Moreover, 60.4% and 24.3% reported that they did not eat the quality or quantity of food they wanted on a daily/weekly or a monthly basis, respectively. Participants reported re-using someone else’s injection equipment: 21% re-used a needle, 19% re-used water, and 37.3% re-used a cooker. The odds of sharing injection equipment were increased for food insecure individuals.ConclusionsFindings show that IDUs have frequent and variable experiences of food insecurity and these experiences are strongly correlated with sharing of injection-related equipment. Such behaviours may increase the likelihood of HIV and HCV transmission in this population. Addressing food-related needs among IDUs is urgently needed.

Social, health and drug use characteristics of primary crack users in three mid-sized communities in British Columbia, Canada

Aims: Despite the increased prevalence of crack use, research on street drug use in Canada currently focusses mainly on injection drug use and/or use in large urban centres. This studys objective was to assess the distinct socio-demographic characteristics, drug-use patterns, health profiles and risk behaviours as well as intervention needs of primary crack users in three mid-sized communities in British Columbia, Canada. Methods: Study participants were recruited with the help of local service agencies and peer recruiters, and assessed between July and November 2008 based on a protocol involving quantitative, qualitative and biological measures. Findings: The majority of the samples: reported unstable housing/homelessness; relied on social benefit payments for income generation; were under current criminal justice supervision; were poly-drug users, using other drugs like alcohol, cannabis or opioids; reported physical and mental health problems; were hepatitis C virus positive; had numerous crack-use episodes per day; frequently shared crack-use paraphernalia; and obtained crack pipe paraphernalia from makeshift items. Conclusions: This study documents crack use as a prevalent street drug use activity associated with extensive social and health risks and harms, which currently are not sufficiently addressed by the existing interventions in the study sites. Concerted attention to, and delivery of, targeted prevention and treatment interventions for the public health problem of crack use in Canada is urgently required.

Crude estimates of cannabis-attributable mortality and morbidity in Canada–implications for public health focused intervention priorities

BACKGROUND Cannabis is the most commonly used drug in Canada; while its use is currently controlled by criminal prohibition, debates about potential control reforms are intensifying. There is substantive evidence about cannabis-related risks to health in various key outcome domains; however, little is known about the actual extent of these harms specifically in Canada. METHODS Based on epidemiological data (e.g. prevalence of relevant cannabis use rates and relevant risk behaviors; risk ratios; and annual numbers of morbidity/mortality cases in relevant domains), and applying the methodology of comparative risk assessment, we estimated attributable fractions for cannabis-related morbidity and mortality, specifically for: (i) motor-vehicle accidents (MVAs); (ii) use disorders; (iii) mental health (psychosis) and (iv) lung cancer. RESULTS MVAs and lung cancer are the only domains where cannabis-attributable mortality is estimated to occur. While cannabis use results in morbidity in all domains, MVAs and use disorders by far outweigh the other domains in the number of cases; the popularly debated mental health consequences (e.g., psychosis) translate into relatively small case numbers. CONCLUSIONS The present crude estimates should guide and help prioritize public health-oriented interventions for the cannabis-related health burden in the population in Canada; formal burden of disease calculations should be conducted.

Feasibility and impact of brief interventions for frequent cannabis users in Canada

Cannabis use is prevalent among young people, and frequent users are at an elevated risk for health problems. Availability and effectiveness of conventional treatment are limited, and brief interventions (BIs) may present viable alternatives. One hundred thirty-four young high-frequency cannabis users from among university students were randomized to either an oral (C-O; n = 25) or a written experimental cannabis BI (C-W; n = 47) intervention group, or to either an oral (H-O; n = 25) or written health BI (H-W; n = 37) control group. Three-month follow-up assessments based on repeated measures analysis of variance techniques found a decrease in the mean number of cannabis use days in the total sample (p = 0.024), reduced deep inhalation/breathholding use in the C-O group (p = 0.003), reduced driving after cannabis use in the C-W group (p = 0.02), and a significant reduction in deep inhalation/breathholding in the C-O group (p = 0.011) compared with controls. Feasibility and short-term impact of the BIs were demonstrated, yet more research is needed.

Interrupting the social processes linked with initiation of injection drug use: Results from a pilot study

BACKGROUND Injection drug use is a skill learned in social settings. Change the Cycle (CTC), a peer-delivered, one-session intervention, is designed to reduce among people who inject drugs (PIDs) injection initiation-related behaviours (i.e., speaking positively about injecting to non-injectors, injecting in front of non-injectors, explaining or showing a non-injector how to inject) and initiation of non-injectors. We hypothesized that participation in CTC would lead to reductions in initiation-related behaviours six months later. METHODS Using respondent driven sampling (RDS), 98 PIDs were recruited in Toronto, Canada to participate in pilot testing of CTC. The baseline session consisted of a structured interview, the peer-delivered CTC intervention, instructions regarding RDS coupon distribution, and an invitation to return in six months for a follow-up interview. For the 84 PIDs completing the six-month interview, we compared initiation-related behaviours at baseline with six-month follow-up. RESULTS The proportion of PIDs offering to initiate a non-injector was reduced from 8.4% (95% CI: 2.5, 15.9) at baseline to 1.59% (95% CI: 0.4, 3.7) at 6-month follow-up. The prevalence of speaking positively about injection to non-injectors also decreased significantly. The proportion of PIDs who helped a non-injector with a first injection at baseline was 6.2% (95% CI: 2.1, 11.3) and at follow-up was 3.5% (95% CI: 0.8, 7.1). Paired analyses of initiator baseline versus follow-up data showed a 72.7% reduction in initiation (95%CI: 47.7, 83.1). CONCLUSIONS While further refinements remain to be tested, pilot study results suggest that CTC holds promise as a prevention intervention.

Characteristics and predictors of health problems from use among high-frequency cannabis users in a Canadian university student population

Aims: Assess key cannabis use, risk and outcome characteristics among high-frequency cannabis users within a university student sample in Toronto, Canada. Methods: N = 134 active universities students (ages of 18–28) using cannabis at least three times per week were recruited by mass advertisement, telephone-screened and anonymously assessed by an interviewer-administered questionnaire. Relevant descriptive statistics are presented; subsequent univariate and multivariate logistic regression analyses (MLRA) identified independent predictors of experiencing physical or mental health problems. Findings: The majority of respondents used cannabis >5 years, almost daily and >1 times/day, socially and medically on occasion. In past 30 days, 79% used cannabis by deep inhalation, 38% drove a car after use, 45% had difficulty controlling or limiting use and 52% experienced negative mental/physical health effects, with few respondents reporting any past treatment. The MLRA identified ‘difficulty controlling or limiting use’ (OR = 3.40, 95% CI = 1.58–7.30), ‘non-white ethnicity’ (OR = 2.78, 95% CI = 1.13–6.83), and ‘living with others’ (OR = 2.37, 95% CI = 1.02–5.55) as independent predictors (p < 0.01) of negative health problems. Conclusions: Our sample was characterized by several use-related risks and problems, which may result in long-term burden of disease. University environment may offer suitable settings for targeted interventions. Determinants of future cannabis use and problems should be assessed in this population.

Emergency departments and street-involved youth: factors influencing utilization

Abstract Homeless youth often have untreated health problems and experience barriers to care. Existing evidence suggests that homeless youth use emergency departments (EDs) more frequently than other youth. We hypothesized that street youth with access to primary care services would be less likely to utilize EDs for health care. Data were drawn from a study of housing security and changes to it over time among 150 youth (16–20 years) recruited from service agencies for street-involved youth. Our findings show that those with access to primary care were actually more likely to use the ED, suggesting that access may encourage further engagement with the health care system. Findings support the need to better understand why access to primary care increases ED use and what could be done to change this pattern.

Substance Use, Health, and Functioning Characteristics of Medical Marijuana Program Participants Compared to the General Adult Population in Ontario (Canada)

ABSTRACT Existent profiles of Medical Marijuana Program (MMP) participants indicate common and co-morbid chronic diseases, yet evidence on disability or functioning as well as comparisons with general populations are largely lacking. This study compared health, substance use, and functioning status among formally approved MMP participants with the general adult population in Ontario (Canada). A community-recruited sample (n = 53) of MMP participants was compared to a sub-sample (n = 510) of the representative Centre for Addiction and Mental Health (CAMH) Monitor (2015 cycle) survey of Ontario general population adults (ages 18+) based on identical telephone-based interviews regarding substance use, health, and functioning measures. Means and standard deviations for all indicators were computed by sex, controlled for age and education, and compared by regression techniques. MMP participants were more likely to be male, younger, and less socio-economically integrated; they indicated more common psychoactive substance (e.g., tobacco, daily cannabis) and psychotropic medication use, as well as overall worse physical and mental health and functioning status. Marked differences between MMP participants and general population adults were observed. MMPs appear to attract individuals with complex chronic health problems; however, little is known about the impact of MMP participation on these.

Brief Intervention Experiences of Young High-Frequency Cannabis Users in a Canadian Setting

High-frequency cannabis use is prevalent among young adults and has been linked to negative health consequences, yet effective therapeutic interventions are currently limited. Brief Interventions (BIs) for problematic substance use have shown promise, but are typically limited to quantitative outcome measures. This study aims to document the qualitative experiences of young, high-frequency cannabis users with BIs. Sixty-two high-frequency cannabis users, recruited from university student populations, participated in one of two newly developed cannabis BIs and were surveyed qualitatively at the 3-month post-intervention follow-up. Results show that 69.4% of the respondents believed they had undergone changes in actions/thinking/attitudes regarding their cannabis use, with diversion to potentially less harmful cannabis use patterns—including reductions in the frequency/quantity of use and declines in deep-inhalation/breath-holding techniques—being reported. Findings suggest that a personalized, interactive, culturally appropriate format may be a promising BI template for this population. Future qualitative research on BI experiences is urgently needed.