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The extent of and factors associated with self-reported overdose and self-reported receipt of naloxone among people who inject drugs (PWID) in England, Wales and Northern Ireland
Katelyn Cullen, Charlotte O'Halloran, Jaquelyn Njoroge, Lucy Jessop, Josie Smith, Professor Vivian Hope, Fortune Ncube
Int J Drug Policy, 46 :34-40, 2017.
Abstract BACKGROUND: Overdose is a major cause of death among PWID, and for opioid overdoses naloxone administration can reduce harm. However, globally there is limited national level data on the extent of non-fatal overdose and naloxone uptake. The first national level data on the extent of self-reported overdose and self-reported receipt of naloxone among UK PWID, providing a baseline to monitor the impact of the recent policy change regarding naloxone availability, is presented. METHODS: Data on self-reported overdose and receipt of naloxone during the preceding year for 2013-2014 from a national survey of PWID was analysed. Participants who reported injecting during the preceding year were included. RESULTS: Participants (3850) were predominantly male (75%); mean age was 36 years. The most commonly injected drugs were: heroin (91%), crack (45%) and amphetamine (29%). 15% (591) reported overdosing during the preceding year. There were no differences in the proportion reporting overdose by age or gender, but overdose was more common among those who: injected multiple drugs; recently ceased addiction treatment; injected with used needles/syringes; ever had transactional sex; had used a sexual health clinic or emergency department and lived in Wales or Northern Ireland. Among those reporting an overdose during the preceding year, a third reported two to four overdoses and 7.5% five or more overdoses; half reported receiving naloxone. Those reporting naloxone receipt in the preceding year were more likely to: live in Wales or Northern Ireland; ever received used needles/syringes; ever been imprisoned; and less likely to have injected two drug types. CONCLUSION: These data provide a baseline for monitoring the impact of the 2015 UK policy change to improve take-home naloxone access. Interventions tackling overdose should promote naloxone awareness and access, and target those who; are poly-drug injectors, have ceased treatment, share needles/syringes and whose drug use links to sexual activity.
Injection into the jugular vein among people who inject drugs in the United Kingdom: Prevalence, associated factors and harms
Professor Vivian Hope, Jenny Iverson, Katelyn Cullen, John V. Parry, Lisa Maher, Fortune Ncube
Int J Drug Policy, 46 :28-33, 2017.
Abstract BACKGROUND: While people who inject drugs (PWID) typically use peripheral veins, some inject into their central veins, including the femoral and jugular veins. Injection into the jugular vein can have serious adverse health consequences, including jugular vein thrombosis, deep neck infections, pneumothorax, endocarditis and sepsis. This study examined the prevalence of, and factors associated with, jugular vein injection among a large sample of PWID in the United Kingdom. METHOD: Unlinked anonymous surveys (2011-14) recruited PWID from agencies providing services to this population. Self-reported demographic and injection-related data were collected from consenting respondents using a brief questionnaire and dried blood spot samples were tested for exposure to HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). Univariate and multivariable logistic regression were used to examine factors associated with jugular vein injection. RESULTS: Among 5261 PWID, one third had injected into a central vein in the previous 28 days, including 6% (n=339) who had injected into their jugular vein and 1% (n=52) who had used this site exclusively for recent injections. Factors independently associated with recent jugular vein injection in multivariable analysis included female gender, a lifetime history of imprisonment, sharing needles and syringes, poly-drug injection and injection into multiple body sites. Jugular vein injection was also associated with experiencing injection-related injuries, although no associations were identified with respect to exposure to blood borne viral infections. CONCLUSION: A significant minority of PWID inject into the jugular vein in the United Kingdom. Public health responses should investigate ways to support and promote good injection site management in order to minimise vascular damage and reduce problems with peripheral venous access. Women who inject drugs, PWID with a history of imprisonment and those people who are experiencing early signs of injection-related skin and soft tissue injuries are priority sub-populations for interventions.
‘It’s breaking quite big social taboos’ violence against women and girls and self-defense training in Nepal
Kay Standing, Sara Parker, Sapana Bista
Women's Studies International Forum Volume 64, Pages 51-58, September, 2017.
Abstract Given the increased vulnerability to, and rise in reports of, sexual violence in post-disaster situations this article seeks to explore the role of self-defense programmes as a response to addressing violence against women and girls. It draws on the authors' experience of post-earthquake Nepal in 2015. We argue that self-defense training can play a crucial role in challenging normative gender roles, raising confidence and self-esteem in girls and women during and post disaster, and call for further research to take place at the local level to explore this important issue further.
Qualitative Health Research, 2017.
Abstract: The growth of the Internet has led to an increase in researchers utilizing online methods. Online communities such as forums, blogs, and video platforms are particularly useful for research involving populations that are Internet savvy, seldom heard or discussing sensitive or illicit behavior. Drawing upon the experiences of four doctoral health students who are using online methods, this article discusses the value and benefits of conducting online research as well as the limitations and difficulties encountered. Consideration is given to the methodological and ethical implications of online research. Our own research leads us to reflect on participants’ perceptions of what is public, preserving anonymity and protecting participants from harm.
Low levels of hepatitis C diagnosis and testing uptake among people who inject image and performance enhancing drugs in England and Wales, 2012-15
Drug and Alcohol Dependence Volume 179, 1 October 2017, Pages 83-86, 2017.
Abstract: Introduction: People injecting image and performance enhancing drugs (IPEDs) have traditionally not been perceived as being at high risk of hepatitis C virus (HCV) infection. However, recent studies indicate the HCV antibody (anti-HCV) prevalence in this group is 10-times that in the general population. HCV testing uptake and undiagnosed infections are examined using data from a voluntary unlinked-anonymous survey. Method: People injecting IPEDs across England and Wales completed a short bio-behavioural survey (2012–15). Anti-HCV status and self-reports of HCV testing were used in the analysis. Results: The participants median age was 31 years, 98% were men, 14% had also injected psychoactive drugs and the anti-HCV prevalence was 4.8% (N = 564). Among those who had never injected psychoactive drugs the anti-HCV prevalence was 1.4%; among those who had recently injected psychoactive drugs (preceding 12 months) prevalence was 39% and among those who had done this previously 14% (p < 0.001). Overall, 37% had been tested for HCV: among those who had recently injected psychoactive drugs 78% had been tested, as had 56% of those who had injected psychoactive drugs previously; 33% of those never injecting psychoactive drugs were tested (p < 0.001). Overall, 44% of those with anti-HCV were aware of this; however, only 14% of those who had never injected psychoactive drugs were aware. Conclusions: One-in-twenty people who inject IPEDs have anti-HCV. HCV infections among those who had never injected psychoactive drugs were mostly undiagnosed, though this group had a lower prevalence. Targeted HCV testing interventions are also needed for those injecting IPEDs.
Reflexivity, positionality and power in cross-cultural participatory action research with research assistants in rural Cambodia
Education Action Research, Pages 1-15 | Received 25 Nov 2016, Accepted 12 May 2017, Published online: 05 Jun, 2017.
Abstract: This paper draws on the experiences of a doctoral student undertaking a cross-cultural, cross-language participatory action research (PAR) project in rural Cambodia. Cambodia is a largely Buddhist country with a complex history of religion, invasion, colonisation, war and oppression. Despite a democratic constitution, political control and fear of challenging authority are ever present; and all had an impact on the participation and development of this project. I recruited eight volunteer community health workers (CHWs) and two research assistants (RAs) with an aim to explore methods and challenges faced when trying to improve health with and for community members. Over eight participatory workshops and a two-day training session CHWs identified, implemented and reflected on solutions to community health problems. Simultaneously, the RAs and I reflected on the processes and challenges we faced. Creating opportunity for reflexivity allowed for discussion to emerge around culture, position and power and how these were impacting on the research process and outcomes. Established social hierarchical power structures in Cambodia presented challenges to undertaking a PAR project with emancipatory and social change aims. Such structures also impacted on the ability and readiness of participants to be critical and analytical. The importance of the RAs as cultural navigators and the necessity of embracing their situated knowledge as both an insider and outsider is a key finding.
Ongoing outbreak of invasive and non-invasive disease due to group A Streptococcus (GAS) type emm66 among homeless and people who inject drugs in England and Wales, January to December 2016
Nick Bundle, Laura Bubba, Juliana Coelho, Rachel Kwiatkowska, Rachel Cloke, Sarah King, Jill Rajan-lyer, Max Courtney-Pillinger, Charles R Beck, Professor Vivian Hope, Theresa Lamagni, Colin S Brown, Daiga Jermacane, Rachel Glass, Monica Desai, Maya Gobin, Sooria Balasegaram, Charlotte Anderson
Euro Surveill, 22, 2017.
Abstract: We report an outbreak of invasive and non-invasive disease due to an unusual type of Streptococcus pyogenes(group A Streptococcus, emm66) among a vulnerable, largely homeless population in southern England and Wales, detected in September 2016. Twenty-seven confirmed cases were subsequently identified between 5 January and 29 December 2016; 20 injected drugs and six reported problematic alcohol use. To date, we have ruled out drug-related vehicles of infection and identified few common risk factors.
‘If I don’t look good, it just doesn’t go up’: A qualitative study of young women’s drinking cultures and practices on Social Network Sites
Int J Drug Policy. 2016 Dec;38:50-62, 2016.
Abstract BACKGROUND: Young women in the UK often partake in a culture of intoxication in the pursuit of pleasure and friendship fun. Experiences of intoxication and drinking spaces remain highly gendered, and relative to men, women continue to find their behaviours in drinking spaces more constrained and scrutinised. Simultaneously, young women now express themselves via Social Network Sites (SNS), where they display drinking experiences and where they perform, negotiate and display contemporary femininities. METHODS: The research explored young women's experiences of drinking and intoxication, the use of SNS in their drinking cultures and the display of drinking practices on SNS through group interviews (n=12) with women (n=37) aged 16-21 from one city in the North-West of England, UK. RESULTS: The practice of uploading drinking photographs to SNS played an important role in displaying young women's popularity, enhancing friendship fun and belonging, and in positioning the hyper-sexual feminine look as the norm in drinking spaces. Both intoxication and the hyper-sexual and feminine look challenged traditional notions of respectable femininity, while the highly groomed feminine look itself was threatened by drunkenness. As such, young women invested much work and effort in self-surveillance and in managing the display of their drinking behaviours on SNS. CONCLUSION: The dilemmas in contemporary femininity created by the juxtaposition of hyper-sexual femininity and the culture of intoxication are reproduced on SNS. Controlling and restricting certain content on SNS with the aim of achieving the 'right' feminine self-presentation resulted in a narrowly set of body oriented and behavioural feminine attributes being presented as the norm, and an overly positive online representation of young women's drinking experiences.
An economic evaluation of contingency management for completion of hepatitis B vaccination in those on treatment for opiate dependence
Rachid Rafia, Peter J Dodd, Alan Brennan, Petra Meier, Professor Vivian Hope, Fortune Ncube, Sarah Byford, Hiong Tie, Nicola Metrebian, Jennifer Hellier, Tim Weaver, John Strang
Addiction, 111 :1616-1627, 2016.
Abstract: AIMS: To determine whether the provision of contingency management using financial incentives to improve hepatitis B vaccine completion in people who inject drugs entering community treatment represents a cost-effective use of health-care resources. DESIGN: A probabilistic cost-effectiveness analysis was conducted, using a decision-tree to estimate the short-term clinical and health-care cost impact of the vaccination strategies, followed by a Markov process to evaluate the long-term clinical consequences and costs associated with hepatitis B infection. SETTINGS AND PARTICIPANTS: Data on attendance to vaccination from a UK cluster randomized trial. INTERVENTION: Two contingency management options were examined in the trial: fixed versus escalating schedule financial incentives. MEASUREMENT: Life-time health-care costs and quality-adjusted life years discounted at 3.5% annually; incremental cost-effectiveness ratios. FINDINGS: The resulting estimate for the incremental life-time health-care cost of the contingency management strategy versus usual care was £21.86 [95% confidence interval (CI) = -£12.20 to 39.86] per person offered the incentive. For 1000 people offered the incentive, the incremental reduction in numbers of hepatitis B infections avoided over their lifetime was estimated at 19 (95% CI = 8-30). The probabilistic incremental cost per quality adjusted life-year gained of the contingency management programme was estimated to be £6738 (95% CI = £6297-7172), with an 89% probability of being considered cost-effective at a threshold of £20 000 per quality-adjusted life years gained (97.60% at £30 000). CONCLUSIONS: Using financial incentives to increase hepatitis B vaccination completion in people who inject drugs could be a cost-effective use of health-care resources in the UK as long as the incidence remains above 1.2%.
“Once you’ve been there, you’re always recovering”: exploring experiences, outcomes, and benefits of substance misuse recovery
Drugs and Alcohol Today, (2016) Vol. 16 Iss: 1, pp.29 - 38, 2016.
Abstract: Purpose: – Recovery is a central component of UK substance misuse policy, however, relatively little is known about the views and meanings of recovery by those experiencing it. The purpose of this paper is to explore these factors, and understand how service user experiences align to current understandings of “recovery capital”. Design/methodology/approach: – This paper draws on qualitative interviews with 32 individuals from six UK recovery communities, including those commissioned by a statutory service (n=8) and a peer-led recovery community (n=24). Findings: – Meanings of recovery differed between people in abstinence-based communities and those not; however, all had consistent views on their own recovery outcomes and the benefits they believed recovery brought. All viewed recovery as a process; a continuous journey with no end-point. Internal motivation, peer support, social networks and daily structure were integral to supporting individuals achieve and maintain recovery. Key benefits of recovery reflected recovery capital and included positive relationships, sense of belonging, increased self-worth and confidence, employment and education. Research limitations/implications: – This research shows that recovery experiences and outcomes are not centred entirely on the individual but are wider, more holistic. Maintaining recovery involves being connected to themselves and to the wider environment: family, friends, peers and society. Although the recovery capital model has many elements that were discussed by the participants of this research, the discourse they used does not align with the model. To validly measure and quantify recovery outcomes, individuals need to identify with the measures themselves. Practical implications: – From policy and commissioning perspectives, these findings suggest benefits of recovery that were viewed by participants as indicators of success: demonstrate elements which support recovery; and highlight key social value outcomes which people attribute to recovery. Social implications: – These “softer”, qualitative benefits should be considered by policy-makers, commissioners, statutory and non-statutory services in order to evidence outcomes. However, it should also be recognised that a temporally static approach to assessing recovery may be in contradiction to the meaning and perspectives held by those in recovery communities who conceptualise it as a long term and ongoing process. Originality/value: – This paper adds to understandings of experiences and meanings of recovery, with a particular focus on the measurement of outcomes and their meanings, and the role of abstention and continued drug use within the recovery process.