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Drug use patterns among Thai illicit drug injectors amidst increased police presence
Dan Werb, Kanna Hayashi, Nadia Fairbairn, Karyn Kaplan, Paisan Suwannawong, Calvin Lai, Thomas Kerr
Substance Abuse Treatment, Prevention, and Policy , 2009, DOI: 10.1186/1747-597x-4-16
Abstract: Drug users in Thailand continue to face a variety of harms. In addition to the health risks associated with the consumption of illicit drugs through injection and other means, Thai drug users face stigmatization and an elevated risk of violence as a result of their government's 'hard line' response to illicit drug use [1]. In February 2003, the Thai government implemented a widely-publicized "War on Drugs" aimed at disrupting a burgeoning demand for methamphetamines [2]. The stated goal of this campaign was to make Thailand "drug free" by targeting drug dealers [1,3]. It has been reported that over 2,200 people, not necessarily drug dealers, were killed during its implementation [3]. Despite a massive outcry from human rights groups and a government pledge to treat drug users "as patients, not criminals" [4,5], the reinstitution of the Thai "War on Drugs" was announced in February 2008. At that time, Thailand's interior minister Chalerm Yubamrong publicly stated that the crackdown would continue even if "thousands of people have to die" [6].Little is known regarding the effect of the Thai War on Drugs on demand for illicit drugs, though recent studies suggest that this campaign may have altered drug use patterns among illicit drug users and reduced consumption of methamphetamine among youth in the short term [7,8]. However, the campaign may have also contributed to a systematic underreporting of illicit drug use and related risk behaviors and may have increased the misuse of diverted licit drugs [7]. This campaign was implemented in response to a massive increase in methamphetamine use among Thais since the mid-1990s, as well as a steady increase in heroin injection that has been linked to the effective eradication of the country's indigenous opium cultivation industry beginning in the 1970s [7]. Research further suggests that the Thai government is continuing to rely on drug crackdowns as a primary response to illicit drug use in the country [9]. We therefore sough
Hunger and associated harms among injection drug users in an urban Canadian setting
Aranka Anema, Evan Wood, Sheri D Weiser, Jiezhi Qi, Julio SG Montaner, Thomas Kerr
Substance Abuse Treatment, Prevention, and Policy , 2010, DOI: 10.1186/1747-597x-5-20
Abstract: We conducted a cross-sectional study to examine the prevalence and correlates of self-reported hunger in a large cohort of IDU in Vancouver, Canada. Food insufficiency was defined as reporting "I am hungry, but don't eat because I can't afford enough food". Logistic regression was used to determine independent socio-demographic and drug-use characteristics associated with food insufficiency.Among 1,053 participants, 681 (64.7%) reported being hungry and unable to afford enough food. Self-reported hunger was independently associated with: unstable housing (adjusted odds ratio [AOR]: 1.68, 95% confidence interval [CI]: 1.20 - 2.36, spending ≥ $50/day on drugs (AOR: 1.43, 95% CI: 1.06 - 1.91), and symptoms of depression (AOR: 3.32, 95% CI: 2.45 - 4.48).These findings suggest that IDU in this setting would likely benefit from interventions that work to improve access to food and social support services, including addiction treatment programs which may reduce the adverse effect of ongoing drug use on hunger.There were between 155 and 250 million illicit drug users worldwide in 2009 [1], including an estimated 16 million injection drug users (IDU) [2]. IDU face multiple structural and behavioral barriers to accessing health care and social support services, which collectively serve to compound health risks and exacerbate poor health outcomes [3]. IDU are known to be vulnerable to developing nutritional deficiencies, and often simultaneously experience numerous forms of micro and macronutrient deficiencies [4,5].Insufficient consumption of food among IDU has been associated with an array of harms. Caloric insufficiency has been correlated with decreased immune function [6] and elevated risk of receiving a positive tuberculin test [7]. Insufficient caloric intake has been additionally associated with increased risk of various health complications including invasive candidiasis, viral hepatitis, bacterial pneumonia, and various infections including subcutaneous and perianal
Consumo ?n?o problemático? de drogas ilegais
Cruz,Olga Souza; Machado,Carla;
Toxicodependências , 2010,
Abstract: illicit drug use is increasingly used by ?conventional? citizens, as a form of diversion and to get pleasure. studies suggest that various drug users are conscious about drugs? potential harms but, taking into account their risks and benefits, decide to use them. however, they do it with some care, using some drug use management strategies, in order to minimize potential harms. the existence of drug users whose global adjustment is not significantly damaged by this practice is nowadays recognized. in this study we call them ?non problematic? illicit drug users, and we intend to explain the processes by which some subjects manage their drug uses in order to keep them as so. the nine participants that integrate this study were selected through theoretic sampling and reached by a snowball strategy, being then subjected to an in-depth interview. data were inductively analyzed, through a grounded analysis process. the main results indicate that ?non problematic? illicit drug users resort to several strategies to manage their habit, namely, the control over the regularity, locations and types of drugs they use. understanding these kinds of strategies may be an important contribution to reduce drug use potential harms and to enhance harm reduction efforts.
Drug Testing for Newborn Exposure to Illicit Substances in Pregnancy: Pitfalls and Pearls  [PDF]
Karen J. Farst,Jimmie L. Valentine,R. Whit Hall
International Journal of Pediatrics , 2011, DOI: 10.1155/2011/951616
Abstract: Estimates of the prevalence of drug usage during pregnancy vary by region and survey tool used. Clinicians providing care to newborns should be equipped to recognize a newborn who has been exposed to illicit drugs during pregnancy by the effects the exposure might cause at the time of delivery and/or by drug testing of the newborn. The purpose of this paper is to provide an overview of the literature and assess the clinical role of drug testing in the newborn. Accurate recognition of a newborn whose mother has used illicit drugs in pregnancy cannot only impact decisions for healthcare in the nursery around the time of delivery, but can also provide a key opportunity to assess the mother for needed services. While drug use in pregnancy is not an independent predictor of the mother's ability to provide a safe and nurturing environment for her newborn, other issues that often cooccur in the life of a mother with a substance abuse disorder raise concerns for the safety of the discharge environment and should be assessed. Healthcare providers in these roles should advocate for unbiased and effective treatment services for affected families. 1. Introduction Estimates of illicit drug use in pregnancy vary widely. Approximately 5–10% of women self-report the use of illicit drugs in pregnancy [1–3], while universal testing for illicit drugs in high-risk populations results in a significantly higher prevalence (10–40%) of usage than through self-reporting [2, 3]. There is a wide range of use varying from infrequent recreational use to high levels of use with physiologic addiction. Importantly, other substances that can have deleterious effects on the mother and infants health (such as nicotine and alcohol) are often used concurrently with illicit drugs [1]. Identification of newborns exposed to illicit drugs in pregnancy cannot only alert the practitioner to problems one might encounter in the delivery room and nursery, but can also serve as an opportunity to recognize and assess families with substance abuse disorders which can pose risks to the newborn after hospital discharge. However, since self-reports of illicit drug use are often inaccurate and universal drug testing is neither practical for the clinician nor recommended by the American Academy of Pediatrics [4], every facility that provides care for newborns should establish their own testing protocol including establishing unbiased guidelines to identify those to be tested. Policies should be in place allowing for confirmation of test results that have been performed by screening methods which provide
Frequency Of Illicit Drug Consumption In The First Trimester Of Pregnancy (Tehran - 2001)
Ramezanzadeh f,Tavafian S S
Tehran University Medical Journal , 2003,
Abstract: Illicit drug abuse is a major area of interest for clinicians, as well as for public health and social authorities, but one of the major concerns is the illicit drug abuse during the periconceptional period and throughout pregnancy, because of its potential effects on the embryo and fetus. In this study we investigated the prevalence of illicit drug abuse in the first trimester of pregnancy in women who referred to Iran, Tehran and Shahid Beheshti universities of medical sciences, for prenatal care."nMaterials and Methods: In this descriptive cross sectional study, a non-randomized sample of 2000 pregnant women that were in their second and third trimester of their pregnancy, were interviewed about drug abuse in their first trimester. Collected data were analyzed by SPSS software."nResults: The prevalence of illicit drug abuse in the first trimester was 2.5% which the majority of these drugs were in group B. The prevalence of drug abuse was 0.9% and alcohol usage and alcohol abuse was 0.2%, cigarette smoking was the most common drug abusing phenomena. Variables such as husband education, infertility and satisfaction with pregnancy have significant relation with drug abuse."nConclusion: The results of this study support the need for continued education and this education must end in by itself to make dramatic changes in behavior. So results of this study showed that, improving education and knowledge of mothers and consultation with them in regard to risks and complications of drug abuse during pregnancy, would make dramatic changes in their behavior."n"n"n"n"n"n"n"n
Analysis on Financial Risks of Derivation and Preventive Measures  [cached]
Yu Pan,Fan Wu
International Business Research , 2009, DOI: 10.5539/ibr.v2n4p73
Abstract: Financial derivatives, as innovative financial instrument, have been designed for enterprises to avoid financial risks. Most of these derivatives rely on future trends of traditional tools, such as valuation, interest rates and exchange rates. Such expected future transactions or events can not be recognized as assets because they do not meet the definition of assets, economic resources owned or controlled by enterprises and only made by past transactions. The use of the traditional accounting model does not accurately disclose this kind of "off-balance-sheet items," and their impact on financial statements. This paper provides some methods for enterprises and government to appropriately recognize and reveal the risks and benefits of financial derivatives.
Nonparametric estimation of risk measures of collective risks  [PDF]
Alexandra Lauer,Henryk Z?hle
Statistics , 2015,
Abstract: We consider two nonparametric estimators for the risk measure of the sum of $n$ i.i.d. individual insurance risks where the number of historical single claims that are used for the statistical estimation is of order $n$. This framework matches the situation that nonlife insurance companies are faced with within in the scope of premium calculation. Indeed, the risk measure of the aggregate risk divided by $n$ can be seen as a suitable premium for each of the individual risks. For both estimators divided by $n$ we derive a sort of Marcinkiewicz--Zygmund strong law as well as a weak limit theorem. The behavior of the estimators for small to moderate $n$ is studied by means of Monte-Carlo simulations.
"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil
Oliveira, Maria de Lourdes Aguiar;Hacker, Mariana A.;Oliveira, Sabrina Alberti Nóbrega de;Telles, Paulo Roberto;ó, Kycia Maria Rodrigues do;Yoshida, Clara Fumiko Tachibana;Bastos, Francisco I.;
Cadernos de Saúde Pública , 2006, DOI: 10.1590/S0102-311X2006000400024
Abstract: the context of first drug injection and its association with ongoing injecting practices and hcv (hepatitis c virus) infection were investigated. injection drug users (idus) (n = 606) were recruited in "drug scenes" (public places, bars) in rio de janeiro, brazil, interviewed, and tested for hcv. sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. among young injectors (< 30 years), those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by hcv. hepatitis c virus prevalence among active idus (n = 272) was 11%. prison history and longer duration of drug injection were identified as independent predictors of hcv infection. to effectively curb hcv transmission among idus and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.
"The first shot": the context of first injection of illicit drugs, ongoing injecting practices, and hepatitis C infection in Rio de Janeiro, Brazil  [cached]
Oliveira Maria de Lourdes Aguiar,Hacker Mariana A.,Oliveira Sabrina Alberti Nóbrega de,Telles Paulo Roberto
Cadernos de Saúde Pública , 2006,
Abstract: The context of first drug injection and its association with ongoing injecting practices and HCV (hepatitis C virus) infection were investigated. Injection drug users (IDUs) (N = 606) were recruited in "drug scenes" (public places, bars) in Rio de Janeiro, Brazil, interviewed, and tested for HCV. Sharing of needles/syringes was more prevalent at the first injection (51.3%) than at the baseline interview (36.8%). Those who shared syringes/needles at first injection were more likely to be currently engaged in direct/indirect sharing practices. Among young injectors (< 30 years), those reporting sharing of needles/ syringes at the first injection were about four times more likely to have been infected by HCV. Hepatitis C virus prevalence among active IDUs (n = 272) was 11%. Prison history and longer duration of drug injection were identified as independent predictors of HCV infection. To effectively curb HCV transmission among IDUs and minimize harms associated with risk behaviors, preventive strategies should target individuals initiating drug injection beginning with their very first injection and discourage the transition from non-injecting use to the self-injection of illicit drugs.
To use or not to use: an update on licit and illicit ketamine use
Jih-Heng Li,Balasingam Vicknasingam,Yuet-wah Cheung,et al
Substance Abuse and Rehabilitation , 2011,
Abstract: Jih-Heng Li1, Balasingam Vicknasingam2, Yuet-wah Cheung3, Wang Zhou4, Adhi Wibowo Nurhidayat5, Don C Des Jarlais6, Richard Schottenfeld71College of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan; 2National Centre for Drug Research, Universiti Sains Malaysia, Malaysia; 3Department of Sociology, The Chinese University of Hong Kong, Hong Kong, China; 4Wuhan Center for Disease Control and Prevention, Wuhan, China; 5Drug Dependence Hospital RSKO, Jakarta, Indonesia; 6Beth Israel Medical Center, New York, NY; 7School of Psychiatry, Yale University, CT, USAAbstract: Ketamine, a derivative of phencyclidine that was developed in the 1960s, is an anesthetic and analgesic with hallucinogenic effects. In this paper, the pharmacological and toxicological effects of ketamine are briefly reviewed. Ketamine possesses a wide safety margin but such a therapeutic benefit is somewhat offset by its emergence phenomenon (mind-body dissociation and delirium) and hallucinogenic effects. The increasing abuse of ketamine, initially predominantly in recreational scenes to experience a “k-hole” and other hallucinatory effects but more recently also as a drug abused during the workday or at home, has further pushed governments to confine its usage in many countries. Recently, urinary tract dysfunction has been associated with long-term ketamine use. In some long-term ketamine users, such damage can be irreversible and could result in renal failure and dialysis. Although ketamine has not yet been scheduled in the United Nations Conventions, previous studies using different assessment parameters to score the overall harms of drugs indicated that ketamine may cause more harm than some of the United Nations scheduled drugs. Some countries in Southeast and East Asia have reported an escalating situation of ketamine abuse. Dependence, lower urinary tract dysfunction, and sexual impulse or violence were the most notable among the ketamine-associated symptoms in these countries. These results implied that the danger of ketamine may have been underestimated previously. Therefore, the severity levels of the ketamine-associated problems should be scrutinized more carefully and objectively. To prevent ketamine from being improperly used and evolving into an epidemic, a thorough survey on the prevalence and characteristics of illicit ketamine use is imperative so that suitable policy and measures can be taken. On the other hand, recent findings that ketamine could be useful for treating major depressive disorder has given this old drug a new impetus. If ketamine is indeed a remedy fo
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