Search

Background: People with Substance Use Disorder have higher adverse outcomes associated with COVID-19 infection that can be reduced with COVID-19 vaccines. Various factors influence the acceptability of COVID-19 vaccines. We assessed COVID-19 vaccine-related knowledge, attitude, and beliefs in patients on Opioid Agonist Treatment (OAT) from a community clinic in an urban impoverished area in Delhi, India. Methods: Cross-sectional design. We interviewed 200 adult males using a structured questionnaire. Results: The participants' mean age was 27.4 (SD 6.8) years; majority (68%, n = 136) had less than 10 years of schooling. While family members of 77% (n = 154) of the participants were vaccinated for COVID-19, only 32% (n = 64) of the participants had been vaccinated with at least a single dose. 43% (n = 86) felt they are ineligible for vaccine due to their addiction or their ongoing addiction treatment (46.5%, n = 93). Though the majority (78.5%, n = 157) were willing to get vaccinated, they had not done so due to concerns, such as fear of vaccine-related adverse-effects (35%). Conclusions: COVID-19 vaccination rates in individuals with opioid dependence are much lower compared to the general population. There are several misconceptions related to COVID-19 vaccinations in this population that needs to be addressed to achieve universal vaccination against COVID-19 infection. [ABSTRACT FROM AUTHOR]

Background: About one-fourth of individuals who are dependent on opioids use opioids through injecting route. Most of such individuals start using opioids through noninjecting route much earlier before they transition to injecting opioids. It is important to identify important factors that delineate individuals who inject opioids from those who use opioids through other routes, which was the objective of the present study. Methods: This was a cross-sectional study design. Four hundred treatment-naïve opioid users with opioid dependence were selected using a snowballing sampling technique. The drug use details, family relations, social and occupational functioning, and peer network history were assessed using a self-developed questionnaire and the use of structured instruments such as the Leeds Dependence Questionnaire Scale, High-Risk Behavior Scale, and Functional Status Questionnaire Scale. Comorbid psychiatric symptoms were assessed using the Generalized Anxiety Disorder-7 and Patient Health Questionnaire-9. The Ask Suicide-Screening Questions was used for assessing different domains of suicidality. Results: The mean age of the participants was 26 (standard deviation = 6) years. One-third (n = 136) of these were injecting opioid users (injecting drug users [IDUs]) and the remaining were taking opioids through other routes (non-IDUs). In multivariate analysis, IDUs (as compared to non-IDUs) had higher rates of family history of opioid use (odds ratio [OR] =3.53, 95% confidence interval: 1.17–8.69), incarceration history (OR = 2.16, 1.78–3.11), lower employment (OR = 0.53, 0.31–0.84), more people with <5 years of education (OR = 4.31, 2.60–12.73), lower age of starting opioid use (OR = 0.44, 0.26–0.69), more concurrent sedative use (OR = 5.60, 4.34–7), more self-harm attempts history (OR = 1.88, 1.16–3.2), larger peer groups (OR = 1.89, 1.11–2.63), and greater involvement in selling illegal drugs (OR = 1.81, 1.49–3.67). Conclusions: Various factors are significantly associated with using opioids through injecting route in individuals with opioid dependence. These factors can help identify individuals with opioid dependence who are likely to transition to injecting opioids. [ABSTRACT FROM AUTHOR]

Background: Integrating mobile technologies in healthcare (mHealth) is helpful to manage various medical conditions. mHealth applications can bridge the gap in the management of patients with opioid use disorder (OUD). Research evaluating the feasibility of mHealth to address OUD is limited in developing countries. We aimed to assess the digital capacity and interest in mHealth interventions in patients maintained on opioid agonist treatment (OAT). Methods: 150 patients on OAT from a community drug treatment clinic in New Delhi, India, were included. We assessed the participants on their pattern of mobile and Internet use and their willingness to use mHealth technology to access health information and services related to OUD. Results: 88% of participants (n = 132) owned a mobile phone at assessment; 2.7% (n = 4) had never used a mobile phone in their lifetime. 70% (n = 105) participants had Internet access. 80% (n = 120) of participants showed interest in receiving text messages related to the management of OUD. 60% of participants showed a willingness to download and use applications for monitoring their substance use. Conclusions: In India, there is an interest among people on OAT to use mHealth interventions to manage their substance use. This population also has access to mobile phones and the necessary knowledge to install and run applications needed for various mHealth interventions. [ABSTRACT FROM AUTHOR]

Purpose: The Hijra community is a cultural and gender grouping in South Asia broadly similar to western transgender communities, but with literature suggesting some differences in gender experience and patterns of psychosocial adversity. The present study aims to describe patterns of mental illness and psychoactive substance use in Hijra subjects and study their association with gender experience and psychosocial adversity. Methods: Fifty self-identified Hijras availing HIV-prevention services in New Delhi, India, were interviewed. Data on mental disorders, psychoactive substance use, quality of life, discrimination, empowerment, violence and gender identity were assessed using structured instruments. Results: Subjects were mostly in their mid-twenties, and had joined the Hijra community in their mid-teens. More subjects (46%) were involved in begging than in traditional Hijra roles (38%). Sex work was reported by 28% subjects. The rates of lifetime mental illness was 38%, most commonly alcohol abuse (26%); others had anxiety or depressive disorders (8% each), somatoform disorders (6%) and bulimia nervosa (n = 1). Disempowerment was mostly experienced in domains of autonomy and community participation; 52% had experienced sexual or psychological violence. Discrimination was attributed to gender (100%), appearance (28%) or sexual orientation (28%). There were negative correlations between the physical domain of WHO-QOL and physical violence and depression scores; and between discrimination and WHO-QOL environmental, physical and psychological domains. Conclusions: This Hijra group showed high rates of mental disorder and substance involvement, related to QOL domains and experiences of discrimination and disempowerment. [ABSTRACT FROM AUTHOR]

Background: Pattern of drinking has a strong bearing on alcohol-related negative consequences. Very few studies from India have assessed this relationship using any standardized instrument. Aim: The current study aims to assess the relationship between pattern of alcohol use and negative consequences among problem alcohol users using a standardized instrument. Materials and Methods: This cross-sectional, observational study using snowball sampling technique was conducted among 75 participants in an urban slum of a metropolitan city of India. Screening of the participants was done by the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO-ASSIST). Alcohol use details and alcohol-related adverse consequences were obtained by a semi-structured questionnaire and Drinker Inventory of Consequences (DrInC) inventory, respectively. Descriptive statistics, Chi-square test, and logistic regression test were used to analyze the data. Results: There was a significant association between high total DrInC score and ≥3 subscale scores with employment status, percentage of total family income spent on alcohol, source of income to procure alcohol, amount of alcohol, morning drinking, alcohol use for relaxation, and drinking throughout the day (Chi-square test). Age ≤35 years, current unemployment/part-time employment state, spending ≥25% of total family income on alcohol, family history, and drinking throughout the day were more likely to have high total DrInC score and ≥2 subscale scores (logistic regression analysis). Conclusion: A large proportion of the participants were suffering significantly from alcohol-related consequences but still were not receiving any treatment. It emphasizes the need for more epidemiological studies in this area for its treatment and policy-level implication. [ABSTRACT FROM AUTHOR]

Background: The type of opioid used influences the severity and complications experienced. Natural opiates (opium and poppy husk) use is a socio-culturally accepted phenomenon reported in India. However, studies on their profile, quality of life, and addiction severity are limited. Objectives: The objective of this cross-sectional, observational study was to assess the socio-demographic profile, clinical profile, addiction severity, and quality of life of treatment-seeking natural opiate users. Method: Hundred subjects aged 18-65 years using opium or poppy husk seeking outpatient treatment at a tertiary addiction treatment center in India were interviewed to collect information on their socio-demography, natural opiate, and other substance use. Additionally, their addiction severity and quality of life were assessed using Addiction Severity Index-Lite and WHO Quality of Life-Bref instrument, respectively. Results: All subjects were male with a mean age of 44.6 (±11.0) years. Majority (97%) used poppy husk daily orally. Curiosity/experimentation (63%) was the most common reason for starting opiate use. The past month rates of tobacco, alcohol, cannabis, and sedative-hypnotics use was 58%, 33%, 3%, and 12%, respectively. Only 4% injected any opioid. Inability to afford opiates (72%) was the most common reason for seeking treatment. Rates of medical, familial, social, psychological, and legal complications were low, while the WHOQOL-BREF scores fell between 40 and 50 across various domains. Conclusions/Importance: Natural opiate users may constitute distinct subgroup of opioid users with fewer/no complications despite long duration of uninterrupted use. These findings would be important in planning management strategies for people dependent on natural opiates. [ABSTRACT FROM AUTHOR]

Introduction: Impact of alcohol on various adverse consequences is also determined by the pattern of consumption. Pattern of drinking from developing countries is an under-researched area. The present study aims to assess the pattern of drinking among nontreatment-seeking problem alcohol users from an urban slum in a metropolitan city of North India. Methodology: Using a cross-sectional study design and employing the snowball method, 75 adult males with problem alcohol use were recruited and interviewed using questionnaire and standard instruments. Results: The median duration of alcohol consumption was 12 (7, 21) years, 90% were drinking daily, 64% were morning drinkers and 92% reported heavy episodic drinking (HED). Three-fourth participants were in the high-risk category of alcohol use as assessed by WHO-ASSIST. One-third were spending 25–50% of their family income on alcohol. The most preferred alcohol beverage was country-made liquor (CML; 54.3%). Most alcohol users preferred drinking at home (58%), alone (67%), in evening or at night (80%). Conclusion: Although many alcohol users consume alcohol in amounts much above the recommended levels, with high rates of HED, they are not on treatment for alcohol-use disorder. Their pattern of alcohol consumption is likely to place them at risk for alcohol-related harmful consequences. [ABSTRACT FROM PUBLISHER]

Introduction: Substance abuse and criminality share a complex relationship. The rates of substance use among the prisoners, and that of criminal acts among substance users in community setting are high. Data from South Asian countries, including from India are inadequate. This study aimed to assess the pattern of criminal acts among opioid-dependent subjects and their substance use pattern in the month before, during and after imprisonment.Methods: Using a cross-sectional study design and purposive sampling, opioid-dependent subjects (n=101) attending two community drug treatment clinics who have had any contact with the law were assessed using a specifically-designed tool to record criminal acts and substance use before, during and after last imprisonment.Results: Most subjects (93%) had committed illegal acts in their lifetime. Physical assault was the most common illegal act, while 23% reported selling drugs and 9% reported committing serious crimes. About 95% were arrested and 92% had spent time in police lockups. About 29% were arrested for drugs possession or drug use, and 3% of injecting drug users arrested for carrying injection equipment. About 85% had been imprisoned at least once, of whom 88% used psychoactive substances in the 1-month period before their last imprisonment. Opioids were the most common substances used daily (68%), followed by cannabis (34%) and alcohol (22%). Ninety-seven percent reported the availability of substances in prisons, and 65% also used substances during their last imprisonment. Cannabis (35%) was the most common substances used in prison followed by opioids (19%). Seventy-six percent used substances soon after prison release, and 13% of opioid users experienced opioid overdose soon after prison release. Use of cannabis, injecting drugs, and opioid use before imprisonment were predictors of substance use in prison.Conclusion: Opioid-dependent people have various contacts with the law, including imprisonment. Many users are dependent on substances during prison-entry, which is an important reason for their continued substance use in prisons. There is a need to provide substance abuse treatment across all stages of criminal justice system. [ABSTRACT FROM AUTHOR]

Background: Studies from developed countries document the presence of injecting drug use among females and significantly higher vulnerabilities and risks as compared with male injecting drug users (IDUs). Studies comparing vulnerabilities and drug use patterns between female and male IDUs are not available for developing countries. Objectives: The aim of the study was to assess the drug use pattern and related HIV vulnerabilities among female IDUs and compare these findings with those from male IDUs from four states of Northeast India. Method: The study used data collected as part of a nationwide study of drug use pattern and related HIV vulnerabilities among IDUs. Ninety-eight female and 202 male IDUs accessing services from harm reduction sites across the four states of Northeast region of India were chosen through random sampling methodology. Drug use pattern, injecting practices, and knowledge of HIV were assessed using a structured questionnaire. Results: Significantly higher proportion of female IDUs was uneducated, unemployed, reported their occupation as sex workers, and switched to injecting drug use faster as compared with male IDUs. Female IDUs practicing sex work differed significantly from those who did not with respect to frequency of daily injections, choice of drugs injected, and concomitant use of non-injecting drugs. More than half of female IDUs initiated sharing within the first month of injecting. Conclusions: The study demonstrates that female IDUs differ from male IDUs in their drug use pattern, initiation into injection as well as injecting behavior, which would be an important consideration during designing of female-specific interventions. [ABSTRACT FROM AUTHOR]