Background The Independent Scientific Committee on Drugs (ISCD) assigned quantitative scores for harm to 20 drugs. We hypothesized that a personalized, ISCD-based Composite Harm Score (CHS) would be associated with poor health outcomes in polysubstance users. Methods A prospective community sample (n=293) of adults living in marginal housing was assessed for substance use. The CHS was calculated based on the ISCD index, and the personal substance use characteristics over four weeks. Regression models estimated the association between CHS and physical, psychological, and social health outcomes. Results Polysubstance use was pervasive (95.8%), as was multimorbid illness (median 3, possible range 0–12). The median CHS was 2845 (interquartile range 1865–3977). Adjusting for age and sex, every 1000-unit CHS increase was associated with greater mortality (odds ratio [OR] 1.47, 95% confidence interval [CI] 1.07–2.01, p = 0.02), and persistent hepatitis C infection (OR 1.29, 95% CI 1.02–1.67, p = 0.04). The likelihood of substance-induced psychosis increased 1.39-fold (95% CI 1.13–1.67, p = 0.001). The amount spent on drugs increased 1.51-fold (1.40–1.62, p < 0.001) and the odds of having committed a crime increased 1.74-fold (1.46–2.10, p < 0.001). Multimorbid illness increased 1.43-fold (95% CI 1.26–1.63, p < 0.001). Conclusions Greater CHS predicts poorer physical, psychological, and social health, and may be a useful quantitative, personalized measure of risk for drug-related harm.
References
[1]
Degenhardt L, Hall W (2012) Extent of illicit drug use and dependence, and their contribution to the global burden of disease. Lancet 379: 55-70. doi:10.1016/S0140-6736(11)61611-5. PubMed: 22225671.
[2]
Degenhardt L, Bucello C, Mathers B, Briegleb C, Ali H et al. (2011) Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Addiction 106: 32-51. doi:10.1111/j.1360-0443.2010.03140.x. PubMed: 21054613.
[3]
Whiteford HA, Degenhardt L, Rehm J, Baxter AJ, Ferrari AJ et al. (2013) Global burden of disease attributable to mental and substance use disorders: findings from the Global Burden of Disease Study. p. 2010. Lancet.
[4]
MacCoun RJ, Reuter P (2001) Drug war heresies: Learning from other vices, times, and places. New York: Cambridge University Press.
[5]
Fischer B, Kendall P, Rehm J, Room R (1997) Charting WHO--goals for licit and illicit drugs for the year 2000: are we 'on track'? Public Health 111: 271-275. doi:10.1016/S0033-3506(97)00053-X. PubMed: 9308373.
[6]
Wood E, Werb D, Kazatchkine M, Kerr T, Hankins C et al. (2010) Vienna Declaration: a call for evidence-based drug policies. Lancet 376: 310-312. doi:10.1016/S0140-6736(10)60958-0. PubMed: 20650517.
[7]
Nutt DJ, King LA, Phillips LD, Drugs Independent Scientific Committee on Drugs (2010) Drug harms in the UK: a multicriteria decision analysis. Lancet 376: 1558-1565. doi:10.1016/S0140-6736(10)61462-6. PubMed: 21036393.
[8]
Caulkins JP, Reuter P, Coulson C (2011) Basing drug scheduling decisions on scientific ranking of harmfulness: false promise from false premises. Addiction 106: 1886-1890. doi:10.1111/j.1360-0443.2011.03461.x. PubMed: 21895823.
[9]
Wood E, McKinnon M, Strang R, Kendall PR (2012) Improving community health and safety in Canada through evidence-based policies on illegal drugs. Open Med 6: e35-e40. PubMed: 22567081.
[10]
van Amsterdam J, Opperhuizen A, Koeter M, van den Brink W (2010) Ranking the harm of alcohol, tobacco and illicit drugs for the individual and the population. Eur Addict Res 16: 202-207. doi:10.1159/000317249. PubMed: 20606445.
[11]
Tyndall MW, Currie S, Spittal P, Li K, Wood E et al. (2003) Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS 17: 887-893. doi:10.1097/00002030-200304110-00014. PubMed: 12660536.
[12]
Malcolm BP, Hesselbrock MN, Segal B (2006) Multiple substance dependence and course of alcoholism among Alaska native men and women. Subst Use Misuse 41: 729-741. doi:10.1080/10826080500391803. PubMed: 16603457.
[13]
Kapadia F, Cook JA, Cohen MH, Sohler N, Kovacs A et al. (2005) The relationship between non-injection drug use behaviors on progression to AIDS and death in a cohort of HIV seropositive women in the era of highly active antiretroviral therapy use. Addiction 100: 990-1002. doi:10.1111/j.1360-0443.2005.01098.x. PubMed: 15955015.
[14]
Vila-Rodriguez F, Panenka WJ, Lang DJ, Thornton AE, Vertinsky T et al. (2013) The Hotel study: multimorbidity in a community sample living in marginal housing. Am J Psychiatry ( in press). doi:10.1176/appi.ajp.2013.12111439.
[15]
Vos T, Flaxman AD, Naghavi M et al. XX (2012) Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2163-2196. doi:10.1016/S0140-6736(12)61729-2. PubMed: 23245607.
[16]
Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K et al. (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380: 2224-2260. doi:10.1016/S0140-6736(12)61766-8. PubMed: 23245609.
[17]
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V et al. (2007) Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet 370: 851-858. doi:10.1016/S0140-6736(07)61415-9. PubMed: 17826170.
[18]
Barnett K, Mercer SW, Norbury M, Watt G, Wyke S et al. (2012) Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 380: 37-43. doi:10.1016/S0140-6736(13)60393-1. PubMed: 22579043.
[19]
Canada Mortgage and Housing Corporation (2009). ffordability Core Housing Need Pp. 81.
[20]
Sobell MB, Maisto SA, Sobell LC, Cooper AM, Sanders B (1980) Developing a prototype for evaluating alcohol treatment effectiveness. In: LC SobellMB SobellE. Ward. Evaluating alcohol and drug abuse treatment effectiveness. New York: Pergamon and Publishing House. pp. 129-150.
[21]
Endicott J (1988) Best Estimate Clinical Evaluation and Diagnosis Form (BECED). New York, NY: Department of Research Assessment and Training, New York State Psychiatric Institute.
[22]
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, fourth Edition. Washington, DC: American Psychiatric Association.
[23]
Goodman SH, Sewell DR, Cooley EL, Leavitt N (1993) Assessing levels of adaptive functioning: the Role Functioning Scale. Community Ment Health J 29: 119-131. doi:10.1007/BF00756338. PubMed: 8500285.
[24]
Marsden J, Gossop G, Stewart D, Best D, Farrell M et al. (1998) The Maudsley Addiction Profile (MAP): a brief instrument for assessing treatment outcome. Addiction 93: 1857-1867. doi:10.1046/j.1360-0443.1998.9312185711.x. PubMed: 9926574.
[25]
Fox J, Hong J (2003) Effect displays in R for multinomial and proportional-odds logit models: extensions to the effects package. J Stat Softw 32: 1-24.
[26]
Urban Health Research Initiative (2013) Drug Situation in; Vancouver Vancouver, BC: BC Centre for Excellence in HIV/AIDS.
[27]
Community Health and Safety Evaluation Project Team (2005) Community. ; Health and Safety Evaluation (CHASE) Project Final Report. Vancouver, BC: BC Centre for Excellence in HIV/AIDS.
[28]
Johnson J, Malchy L, Mulvogue T, Moffatt B, Boyd S et al. (2008) Lessons learned from the SCORE project: A document to support outreach and education related to safer crack use. Vancouver, BC: Nursing and Health Behaviour Research Unit, University of British Columbia.
[29]
Mathers BM, Degenhardt L, Bucello C, Lemon J, Wiessing L et al. (2013) Mortality among people who inject drugs: a systematic review and meta-analysis. Bull World Health Org 91: 102-123. doi:10.2471/BLT.12.108282. PubMed: 23554523.
[30]
Degenhardt L, Singleton J, Calabria B, McLaren J, Kerr T et al. (2011) Mortality among cocaine users: a systematic review of cohort studies. Drug Alcohol Depend 113: 88-95. doi:10.1016/j.drugalcdep.2010.07.026. PubMed: 20828942.
Devlin RJ, Henry JA (2008) Clinical review: Major consequences of illicit drug consumption. Crit Care 12: 202. doi:10.1186/cc6423. PubMed: 18279535.
[33]
O'Driscoll PT, McGough J, Hagan H, Thiede H, Critchlow C et al. (2001) Predictors of accidental fatal drug overdose among a cohort of injection drug users. Am J Public Health 91: 984-987. doi:10.2105/AJPH.91.6.984. PubMed: 11392946.
[34]
Larney S, Randall D, Gibson A, Degenhardt L (2012) The contributions of viral hepatitis and alcohol to liver-related deaths in opioid-dependent people. Drug Alcohol Depend http://dx.doi.org/10.1016/j.drugalcdep.2？012.11.012.
[35]
Zhang T, Li Y, Ho W-Z (2006) Drug abuse, innate immunity and hepatitis C virus. Rev Med Virol 16: 311-327. doi:10.1002/rmv.508. PubMed: 16933366.
[36]
Caton CLM, Drake RE, Hasin DS, Dominguez B, Shrout PE et al. (2005) Differences between early-phase primary psychotic disorders with concurrent substance use and substance-induced psychoses. Arch Gen Psychiatry 62: 137-145. doi:10.1001/archpsyc.62.2.137. PubMed: 15699290.
[37]
Caton CLM, Hasin DS, Shrout PE, Drake RE, Dominguez B et al. (2006) Predictors of psychosis remission in psychotic disorders that co-occur with substance use. Schizophr Bull 32: 618-625. PubMed: 16873441.
[38]
Mathias S, Lubman DI, Hides L (2008) Substance-induced psychosis: a diagnostic conundrum. J Clin Psychiatry 69: 358-367. doi:10.4088/JCP.v69n0304. PubMed: 18278990.
[39]
Connell PH (1958) Amphetamine Psychosis. London: Chapman & Hall Ltd.
[40]
Shand FL, Degenhardt L, Slade T, Nelson EC (2011) Sex differences amongst dependent heroin users: Histories, clinical characteristics and predictors of other substance dependence. Addict Beh 36: 27-36. doi:10.1016/j.addbeh.2010.08.008. PubMed: 20833480.
[41]
Drake RE, Wallach MA, Alverson HS, Mueser KT (2002) Psychosocial aspects of substance abuse by clients with severe mental illness. J Nerv Ment Dis 190: 100-106. doi:10.1097/00005053-200202000-00006. PubMed: 11889363.
[42]
Levine SR, Brust JC, Futrell N, Ho KL, Blake D et al. (1990) Cerebrovascular complications of the use of the "crack" form of alkaloidal cocaine. N Engl J Med 323: 699-704. doi:10.1056/NEJM199009133231102. PubMed: 2388668.
[43]
DeBeck K, Kerr T, Li K, Fischer B, Buxton J et al. (2009) Smoking of crack cocaine as a risk factor for HIV infection among people who use injection drugs. CMAJ 181: 585-589. doi:10.1503/cmaj.082054. PubMed: 19841052.
