Search

En réponse à la crise des opioïdes qui sévit en Amérique du Nord, plusieurs autorités sanitaires ont récemment déconseillé la prescription d’analgésiques opioïdes aux personnes ayant un historique d’utilisation de substances. Identifiées comme une population à risque de dépendance et de décès liés aux opioïdes, les personnes utilisatrices de drogues (PUD) souffrant de douleurs semblent particulièrement exposées à des difficultés de prise en charge. Une synthèse des connaissances sur les problèmes de douleur chez les PUD apparait donc hautement nécessaire dans le contexte actuel. L’objectif de cet article est de recenser et discuter la littérature disponible au sujet de (1) la prévalence de la douleur physique aiguë et chronique chez les PUD, (2) la prise en charge de leurs douleurs dans les services de santé, et (3) leurs pratiques d’automédication de la douleur. Afin d’identifier les enjeux de société et de santé publique soulevés par la douleur des PUD, nous mobilisons également des études sociologiques et anthropologiques sur l’expérience de la douleur en population générale. Ce travail souligne les difficultés de reconnaissance de la douleur des PUD par les professionnels de santé, tout en interrogeant les liens entre les barrières d’accès des PUD à une prise en charge médicale et leurs pratiques d’automédication de la douleur. En donnant l’occasion d’envisager la douleur des PUD en tant que phénomène collectif sur les plans populationnel et sociologique, cet article ouvre de nouvelles pistes pour la recherche, l’intervention auprès de PUD souffrant de douleurs, ainsi que l’orientation des politiques de santé en la matière., As a response to the current opioid crisis in North America, several health authorities have recommended not to prescribe opioid painkillers to people with a history of substance use. People who use drugs (PWUD) suffering from chronic pain are identified as a population at risk of opioid-related mortality and addiction. As such, they are likely to experience barriers of access to pain management. In this context, a knowledge synthesis about chronic pain in PWUD is highly needed. This article aims at identifying and discussing the available literature pertaining to (1) the prevalence of acute and chronic physical pain among PWUD, (2) the management of their pain in health services, and (3) their experience with self-medication of pain. To identify the intermingling social and public health issues raised by PWUD’s pain, we propose to make a link between epidemiological studies of PWUD’s pain and socio-anthropological studies of pain experience in the general population. This review shows that caregivers hardly acknowledge the existence of PWUD’s pain. We also examine the links between PWUD’s self-medication of pain and their barriers of access to medical pain management. By offering the opportunity to consider PWUD’s pain as a collective phenomenon at populational and sociological levels, this article opens new avenues for research, intervention with PWUD suffering from pain, and health policies in this area., En respuesta a la “crisis de los opioides” que hace estragos en América del Norte, numerosas autoridades sanitarias han desaconsejado últimamente la prescripción de opioides para el dolor en los casos de las personas que tienen una historia de abuso de sustancias. Identificadas como población a riesgo desde el punto de vista de la dependencia y de la mortalidad relacionada con los opioides, estas personas consumidoras de drogas que sufren dolor parecen particularmente expuestas a dificultades relacionadas con la obtención de tratamiento para el dolor. Una síntesis de los conocimientos sobre los problemas de dolor en estas personas se hace por lo tanto muy necesaria en el contexto actual. El objetivo de este artículo es el de recensar y discutir la bibliografía disponible sobre lo siguiente: 1) la prevalencia del dolor físico agudo y crónico entre las personas que consumen drogas, 2) el tratamiento de sus dolores en los servicios de salud y 3) las prácticas de automedicación para el dolor de estas personas. Con el fin de identificar las cuestiones de sociedad y de salud pública que plantea el dolor de las personas consumidoras de drogas, apelamos igualmente a estudios sociológicos y antropológicos sobre la experiencia del dolor en la población en general. Este trabajo destaca las dificultades que tienen los profesionales de la salud para reconocer el dolor entre quienes consumen drogas y averigua al mismo tiempo los vínculos entre las barreras que experimentan estas personas consumidoras en el acceso al tratamiento y sus prácticas de automedicación para el dolor. Al ofrecer la ocasión de considerar el dolor de los consumidores de drogas como fenómeno colectivo en los planos poblacional y sociológico, este artículo abre nuevas pistas para la investigación, la intervención ante las personas consumidoras que sufren dolores y la orientación de las políticas de salud en la materia.

Alors que la passion est un concept prometteur pour comprendre les comportements de jeux de hasard et d’argent, son influence chez les joueurs de poker etait meconnue. A partir de l’exemple d’une etude mixte sequentielle en deux phases consecutives, l’objectif est de decrire le rationnel de l’utilisation d’une methodologie mixte et ses implications dans la comprehension du phenomene de la passion du poker. La premiere phase quantitative a permis de documenter la force et le sens de l’association entre la passion et les problemes de jeu tandis que la seconde phase qualitative contextualise et donne une signification aux resultats quantitatifs tout en documentant l’utilite du concept de passion en prevention et intervention. En plus de permettre d’approfondir l’ensemble des donnees obtenues dans les deux phases, l’utilisation d’une methodologie mixte a permis de compenser certaines limites inherentes a chaque methode, rendant ainsi possible de faire avancer les connaissances et de mieux appuyer les recommandations.

Recent studies have highlighted the efficacy of and willingness to use pre-exposure prophylaxis (PrEP) to prevent HIV infection among people who inject drugs (PWID), however knowledge of real-world applicability is limited. We aimed to quantify the real-world eligibility for HIV-PrEP among HIV-negative PWID in Montreal, Canada (n = 718). Eligibility was calculated according to US Centers for Disease Control and Prevention (CDC) guidelines and compared to risk of HIV acquisition according to the assessing the risk of contracting HIV (ARCH-IDU) risk screening tool. Over one-third of participants (37%) were eligible for HIV PrEP, with 1/3 of these eligible due to sexual risk alone. Half of participants were considered high risk of HIV acquisition according to ARCH-IDU, but there was poor agreement between the two measures. Although a large proportion of PWID were eligible for HIV-PrEP, better tools that are context- and location-informed are needed to identify PWID at higher risk of HIV acquisition.

OBJECTIVE: Despite the risks associated with poker and its unique characteristics when compared with other forms of gambling, little knowledge exists of poker players’ perceptions of prevention strategies. The aim of this study was to explore poker players’ perceptions and understandings of existing problem gambling prevention strategies. METHODS: This exploratory qualitative study is a secondary data analysis of interviews conducted as a part of a sequential mixed-methods research project, with 12 poker players. RESULTS: Two main themes emerged from the thematic analysis highlighting a distinction between institutional and personal prevention strategies. When speaking about institutional prevention efforts, players were critical of existing formats, messages, and who these messages were being developed and disseminated by and for. Players believed existing messaging strategies demonstrate an overall lack of awareness concerning the reality of poker. Personal preventive strategies that players themselves put in place to reduce risks included money management, playing for free, maintaining a healthy play-life balance, and managing emotions, to be aware of their relationship with poker, as well as spotting paying opportunities. CONCLUSIONS: Given poker players’ lack of receptivity to existing prevention messaging, it is essential to consider the unique nature of poker and its players. It is also imperative to explore the potential benefits of collaborating with players when it comes to targeted prevention strategies.

Background In Canada, the rise in prescription opioid (PO) overdoses and addiction is a major public health concern. Various health authorities have recently recommended that physicians use caution when prescribing opioids, especially to people with histories of substance use. As a result, fewer therapeutic options are available for people who use drugs (PWUD) and suffer from chronic non-cancer pain (CNCP). This paper examines how PWUD describe their experiences with CNCP management in the context of the opioid crisis. Methods This qualitative study is based on in-depth interviews with Montreal (Canada) PWUD experiencing CNCP for 3 months or more. Results Most of the 25 participants (27–61 years; 10 women, 15 men) were polysubstance users (cocaine, opioids, amphetamine, etc.) suffering from CNCP for several years, with multiple additional health and social problems. The majority were unsatisfied with their CNCP management. They felt labelled as “addicts” and stigmatized within the healthcare system. Many participants had been denied PO, even those with severe CNCP and those who were not opioid-dependent. Participants expressed a desire to access non-pharmacological CNCP therapies, but these were often too expensive. Some PWUD were offered methadone to relieve CNCP and found this inappropriate. As a last resort several participants reported self-medicating CNCP with street drugs, increasingly known to be laced with fentanyl. Conclusion PWUD with CNCP are affected by two opioid crises: the PO crisis and the street-opioid crisis. The lack of a coherent policy that addresses their pain management produces reoccurring problems when seeking CNCP relief. Restrictive prescription measures implemented in response to the PO crisis may have consequences similar to prohibitionist policies: they heighten overdose risks for PWUD by increasing exposure to street drugs laced with fentanyl. Improving access to diverse CNCP management options for PWUD can help reduce harms related to street-opioid use.

• Background Chronic noncancer pain (CNCP) is highly prevalent among people who use illicit drugs (PWUD). PWUD suffering from CNCP are at the crossroads of two opioid crises: the prescription opioid crisis and the street-opioid overdose crisis. This qualitative study aims to improve knowledge of the substance use habits of PWUD suffering from CNCP and to assess the role of CNCP in the evolution of their substance use patterns. • Methods In-depth semi-structured interviews were conducted with PWUD suffering from CNCP recruited in Montreal (Canada). To be eligible, participants had to self-report using cocaine and/or street opioids and having pain for at least three months. Twenty-five participants were recruited (10 women, 15 men; aged 27 to 61). Interviews were analyzed within a thematic framework. • Results CNCP could contribute to either increasing or distancing from substance use. Participants described patterns of substance use with several interlaced purposes: recreational, CNCP relief, “emotional” pain relief, and withdrawal symptom control. In several cases, participants’ awareness of their CNCP was delayed by the relieving effects of the substances they used for recreational purposes. Self-medication for CNCP was seldom the primary purpose of the participants’ substance use. Many participants were reluctant to self-manage CNCP with street drugs, but some did so when experiencing recurrent problems accessing healthcare services for CNCP. • Conclusions Suffering from CNCP complexifies PWUD’s substance use patterns. In the opioid crisis context, new health policies and interventions should be implemented to improve PWUD’s pain management and foster their addiction recovery.

Background High-risk injection behaviors are associated with high prevalence of mental health problems among people who inject drugs (PWID). However, whether the use of mental health services is associated with lower risk of sharing injection material remains undetermined. This study aims to examine the association between mental health service utilisation and receptive sharing risk, and determine the potential modifying effect of psychological distress on this association. Methods Participants answered an interviewer-administered questionnaire at 3-month intervals gathering information on sociodemographic characteristics, substance use and related behaviors, services utilisation and significant mental health markers. Relationship between the use of mental health services and receptive sharing was modeled using the generalized estimating equation (GEE), controlling for age at baseline, gender, and other potential confounders. Psychological distress was estimated using the Kessler Psychological Distress Scale (K10). Effect modification was investigated by adding an interaction term in the univariate GEE analysis. Results 358 participants contributed to 2537 visits (median age 40.3, 82% male). Mental health service utilisation was reported in 631 visits (25%), receptive sharing in 321 visits (13%) and severe psychological distress in 359 visits (14%). In multivariate GEE analyses, a significant association was identified between receptive sharing and the use of mental health services (aOR = 0.69; 95% CI = 0.50–0.94). We found no evidence of effect modification by psychological distress. Conclusion Among PWID, mental health service utilisation was associated with lower likelihood of receptive sharing, regardless of level of psychological distress. These findings should be taken into account when designing harm reduction strategies for this population.

Problématique et objectifLes hommes gais et bisexuels consomment davantage de drogues que leurs pairs hétérosexuels. Cependant, peu d’études ont analysé les liens entre l’ensemble des dimensions du vécu homosexuel et la consommation problématique de drogues. L’objectif de cette étude est de décrire et de comprendre les interrelations entre certaines dimensions du vécu homosexuel et les trajectoires de consommation de substances psychoactives (SPA) chez les hommes gais et bisexuels.MéthodologieUne étude qualitative reposant sur une perspective interactionniste symbolique a été effectuée. Des entrevues semi-dirigées ont été menées auprès de 35 hommes gais/bisexuels, ayant une consommation problématique de SPA, âgés de 18 ans et plus, nés au Canada et habitant le grand Montréal. Une analyse thématique a été effectuée.RésultatsLes trajectoires addictives et le vécu homosexuel chez les hommes gais et bisexuels s’entrecroisent à différents moments. En effet, les difficultés relatives à l’acceptation de l’orientation sexuelle, le rejet et la stigmatisation, la rencontre des pairs, les relations affectives et sexuelles et la socialisation dans le milieu gai modulent, de façon bidirectionnelle, l’initiation à la consommation de substances ainsi que les variations de celle-ci.DiscussionLes résultats montrent la nécessité de favoriser un environnement social favorable au développement de l’identité relative à l’orientation sexuelle. En termes de prévention de la consommation problématique de SPA et de la prise en charge des personnes vivant ces problèmes, il est nécessaire d’intégrer les différentes dimensions du vécu homosexuel., Background and objectiveGay and bisexual men use more psychoactive substances than their heterosexual peers do. However, few studies have analyzed the links between all the dimensions of the gay life-course experience and problematic substance use (SU). The objective of this study is to describe and understand the interrelations between certain dimensions of the gay life-course experience and SU trajectories of gay and bisexual men.MethodsA qualitative study based on a symbolic interactionist perspective was conducted. Semi-structured interviews were conducted with 35 gay/bisexual men whose use of psychoactive substances was problematic, and who were 18 years of age or more, born in Canada and living in the Greater Montreal area. A thematic analysis was performed.ResultsFor gay and bisexual men, SU trajectories and the gay life-course experience intersect at various points in time: when they discover and accept their homoerotic desires; when they engage in sexual experimentation; when they meet a sexual/romantic partner or are in a couple relationships; and when they socialize in the gay community, notably in sexualized social settings. According to them, SU in these settings is trivialized, or even encouraged.DiscussionThe results show the need to foster a supportive social environment for the development of sexual orientation identity. In terms of preventing problematic substance use and offering sensitive services for people living with these problems, it is necessary to integrate the different dimensions of the gay life-course experience., Problemática y objetivosLos hombres gays y bisexuales consumen más drogas que sus pares heterosexuales. Sin embargo, pocos son los estudios que han analizado el vínculo entre el conjunto de dimensiones de la vivencia homosexual y el consumo problemático de drogas. Este estudio tiene como objetivo describir y comprender las interrelaciones entre ciertas dimensiones de la vivencia homosexual y las trayectorias de consumo de sustancias psicoactivas entre los hombres gays y bisexuales.MetodologíaSe llevó a cabo un estudio cualitativo que reposa en una perspectiva interaccionista simbólica. Se realizaron entrevistas semidirigidas con 35 hombres gays y bisexuales que tenían un consumo problemático de sustancias psicoactivas, de 18 años o más, nacidos en Canadá y que viven en la región metropolitana de Montreal. Se efectuó un análisis temático.ResultadosLas trayectorias adictivas y la vivencia homosexual entre los hombres gays y bisexuales se entrecruzan en diferentes momentos. En efecto, las dificultades relativas a la aceptación de la orientación sexual, el rechazo y la estigmatización, el encuentro entre pares, las relaciones afectivas y sexuales y la socialización en el medio gay modulan, de manera bidireccional, la iniciación al consumo de sustancias, así como las variaciones de estas.DiscusiónLos resultados muestran la necesidad de favorecer un medio ambiente social favorable al desarrollo de la identidad relativa a la orientación sexual. En cuanto a la prevención del consumo problemático de sustancias psicoactivas y a la atención de las personas que viven este problema, es necesario integrar las diferentes dimensiones de la vivencia homosexual en estos servicios.

BACKGROUND Alternative screening questions could permit low-risk men who have sex with men (MSM) to donate blood without a time deferral. We performed a study to determine the proportion of current donors who may be deferred by various questions and their comfort with them. STUDY DESIGN AND METHODS Donors attending collection sites in Canada in January and February 2018 were offered one of two questionnaires but not both. Questionnaire 1 asked about risk behaviors; Questionnaire 2 rated comfort with the questions. Volunteers uncomfortable with questions participated in short qualitative telephone interviews to understand reasons. Quantitative data were analyzed using χ2 statistics. RESULTS Of 36 241 donors attending, 31 904 (88%, Period 1) completed Questionnaire 1; of 34 947, a total of 30 278 (87%, Period 2) completed Questionnaire 2; 294 completed an interview. In the past 3 months 3.1% (95% confidence interval [CI], 3.1%-3.6%) had more than one partner; 6.0% (95% CI, 5.7%-6.2%) had a new partner; 6.7% (95% CI, 6.4%-6.9%) were in a nonexclusive relationship; 11.2% (95% CI, 10.9%-11.6%) had at least one of these; 3.7% (95% CI, 3.4%-3.9%) had anal sex; and 62.8% (95% CI, 62.2%-63.3%) had condomless sex. More than 6% were uncomfortable with each question, but more (17.2%; 95% CI, 16.8%-17.7%) were uncomfortable with anal sex. Key reasons for discomfort were questions being too personal and unclear safety benefit. CONCLUSION Most donors are comfortable answering alternative questions (except very personal ones) but question the benefit. Implementing alternative questions would result in substantive deferrals. Other policies such as using an MSM capture question to ask additional questions only to MSM should be considered.

Introduction Most studies on chronic noncancer pain (CNCP) in people who use drugs (PWUD) are restricted to people attending substance use disorder treatment programs. This study assessed the prevalence of CNCP in a community-based sample of PWUD, identified factors associated with pain, and documented strategies used for pain relief. Methods This was a cross-sectional study nested in an ongoing cohort of PWUD in Montreal, Canada. Questionnaires were administered to PWUD seen between February 2017 and January 2018. CNCP was defined as pain lasting three or more months and not associated with cancer. Results A total of 417 PWUD were included (mean age = 44.6 ± 10.6 years, 84% men). The prevalence of CNCP was 44.8%, and the median pain duration (interquartile range) was 12 (5–18) years. The presence of CNCP was associated with older age (>45 years old; odds ratio [OR] = 1.8, 95% CI = 1.2–2.7), male sex (OR = 2.3, 95% CI = 1.2–4.2), poor health condition (OR = 1.9, 95% CI = 1.3–3.0), moderate to severe psychological distress (OR = 2.9, 95% CI = 1.8–4.7), and less frequent cocaine use (OR = 0.5, 95% CI = 0.3–0.9). Among CNCP participants, 20.3% used pain medication from other people, whereas 22.5% used alcohol, cannabis, or illicit drugs to relieve pain. Among those who asked for pain medication (N = 24), 29.2% faced a refusal from the doctor. Conclusions CNCP was common among PWUD, and a good proportion of them used substances other than prescribed pain medication to relieve pain. Close collaboration of pain and addiction specialists as well as better pain assessment and access to nonpharmacological treatments could improve pain management in PWUD.

Investigating factors that influence a person’s ability to control gambling behaviour is important. The Dualistic Model of Passion, which includes both harmonious and obsessive passion, has propose...

Introduction and Aims Tranquilizer use is associated with negative health outcomes among people who use drugs. This paper aims to estimate the incidence rate (initiation) and identify predictors of tranquilizer misuse (TM) among cocaine users. Design and Methods A prospective cohort study was conducted in Montreal, Canada. Interviewer-administered questionnaires were carried out at 3-month intervals. Initiation was defined as misusing a tranquilizer for the first time during follow-up. ‘Lasting-initiation’, defined as reporting TM at the next visit following first use, was also examined. Cox proportional hazard regression analyses were carried out to assess predictors of initiation to TM. Results Among the 245 participants who were eligible for the initiation analyses, 123 started TM during follow-up for an incidence rate of 40.49 per 100 person-years (95% confidence interval, CI: 33.80–48.15). Of the 123 initiates, 35.7% were still using at the interview following initiation for an incidence rate of 14.70 per 100 person-years (95% CI: 10.82–19.56). Multivariate models showed that independent predictors of initiation and ‘lasting initiation’ were identical as having had a criminal activity as the main source of income, having been recently in treatment for a substance use disorder (SUD) and reporting non-medical use of prescription opioids. Discussion and Conclusions The incidence rate of TM initiation was high among a sample of cocaine users. Initiation was predicted by a problematic drug use pattern involving polydrug use, involvement in the street economy and having been in treatment for a SUD. These findings have implications for prevention and harm reduction strategies.

Poker playing is a concern because of the large amounts of money spent and the high prevalence of gambling problems. Few studies have taken an interest in poker players’ (PPs’) perspectives. The goal of this qualitative study was to describe PPs’ perceptions of the change in their poker playing and to compare their perception to the variation in the score of a screening tool. A convenience sample of 25 PPs participated in a qualitative interview and completed the Problem Gambling Severity Index (PGSI) 2 years in a row. Of these 25 PPs, 19 perceived a decrease in their poker habits, three perceived an increase, and the other three, no change. The perception of 60% of the PPs was inconsistent with the PGSI; most of those who perceived a decrease in fact had an increase. This study highlights how difficult it is for gamblers to be aware of the changes in their gambling and the importance to develop tools for responsible gambling. These tools would allow gamblers to become aware of their current gambling habits and their evolution.

Background The distribution of safer crack-smoking equipment has been implemented in several Canadian cities to reduce potential health risks such as transmission of blood borne viruses (BBV). Little is known about the perspectives of persons who smoke crack (PWSC) on sharing crack-smoking materials or using in settings where safer crack-smoking equipment is provided. This paper presents data from the perspective of PWSC in Montreal on their experiences of, and rationales for, sharing crack-smoking equipment, in light of the risks of BBV transmission. Methods This qualitative study is based on analyses of BBV risk behaviours among people who use cocaine. Thirty-two semi-structured interviews were conducted in low-threshold community centres for persons who use drugs. Twenty-six interviewees who used cocaine also smoked crack, and constitute a subsample for analyses. Interview transcripts were coded inductively and analyzed thematically from a symbolic interactionist perspective. Results Participants demonstrated personal agency by adopting strategies to minimise sharing of smoking equipment. These included being firm in refusal to share, smoking alone, and keeping an extra pipe to give to others. Nonetheless, sharing seemed to be commonplace and was attributed to contextual and personal factors. These were linked to the social dynamics among smokers; economic reasons such as wanting to keep the accumulated crack resin; practical reasons such as lacking own smoking equipment; being ashamed to purchase or acquire crack pipes; fatalism; poor personal agency; and ambivalence or scepticism towards BBV transmission risks. Conclusion To reinforce harm reduction for PWSC, interventions aimed at reducing barriers to safer smoking practices should be developed at both structural and individual levels.

Background Prescription opioid (PO) injection and poly-drug use have been associated with hepatitis C virus (HCV) infection among people who inject drugs (PWID). Poly-drug use is often a barrier to key HCV preventive programmes including opioid agonist treatment. The contribution of specific drug combinations to high HCV incidence in poly-drug users has not been assessed previously. Addressing this knowledge gap could enhance HCV treatment and prevention efforts. We examined the association between specific drugs and number of drugs used in addition to injected POs, and HCV seroconversion. Methods PWID participating in a cohort study in Montreal (HEPCO), HCV-seronegative at baseline and followed between 2004 and 2013, were included. Data were collected by interview-administered questionnaires. Blood samples were tested for HCV new infections at each 3–6 month follow-up visit. Time-varying Cox regression models were utilized. Results Of 356 participants (81.5% males; mean age: 34.7 years), 123 (34.6%) reported injected POs in the past month at baseline. In univariate analyses, recent use of the following drugs was associated with HCV seroconversion: injected POs, injected cocaine, injected heroin, non-injected tranquilisers, and smoked crack/cocaine. The relative excess risk of HCV seroconversion due to interaction (RER1 HR ) was the highest for co-use of injected POs with the following substances: injected cocaine (RER1 HR =3.44), smoked crack/cocaine (RER1 HR =1.27), and non-injected tranquilisers (RER1 HR =0.8). In addition, a significant linear trend (p Conclusion Specific drugs and number of drugs used in addition to injected POs play a modulating role in the risk of HCV primary infection. Poly-drug use among people who inject POs has to be addressed in order to improve harm reduction programmes and reduce HCV transmission in this high-risk population.

Background Until the early 2000s, people who inject drugs (PWID) in Quebec had mainly been injecting powder cocaine and heroin. Since then, ethnographic studies have shown that the drug market has diversified, with crack and prescription opioids (PO) becoming increasingly available. This could have led to changes in drug use practices among PWID. The objectives of our study were to examine annual trends in injection of different drugs, crack smoking and frequent injection (FI), as well as relationships between injected drugs and FI. Methods PWID are participants in the ongoing Quebec SurvUDI surveillance system. PWID (past 6 months) were recruited in 2 urban and 6 semi-urban/rural sites. Each visit included a structured interview addressing drug use behaviours. Analyses were carried out using GEE methods. For trend analyses (2003–2014) on drugs and FI (number of injections≥upper quartile, previous month), the first annual interview was selected for PWID with multiple participations per year. Analyses on associations between FI and types of injected drugs were based on all interviews (2004–2014). Results Crack/cocaine and heroin injection declined significantly, with prevalence ratios (PR) per year of 0.983 [95% confidence interval (CI): 0.980–0.986] and 0.979 (95% CI: 0.969–0.990), while PO injection [PR=1.052 (1.045–1.059)], crack smoking [PR=1.006 (1.001–1.012)], and FI (≥120 injections, previous month) significantly increased [PR=1.015 (1.004–1.026)]. Compared to PWID who injected crack/cocaine±other drugs, the proportion of PWID reporting FI was higher among those who injected PO+heroin/speedball, crack/cocaine or other drugs (adjusted PR 2.29; 95% CI: 2.07–2.53) or PO only (aPR 1.72; 95%CI: 1.47–2.01). Conclusions Changes that have occurred in the drug market are reflected in PWID's practices. The high frequency of injection observed among PO injectors is of particular concern. Drug market variations are a challenge for health authorities responsible for harm reduction programs.

The concept of passion is relevant to understanding gambling behaviours and gambling problems. Longitudinal studies are useful to better understand the absence and development of gambling problems; however, only one study has specifically considered poker players. Using a longitudinal design, this study aims to determine the influence, 1 year later, of two forms of passion-harmonious and obsessive-on gambling problems in poker players. A total of 116 poker players was recruited from across Quebec, Canada. The outcome variable of interest was participants' category on the Canadian Pathological Gambling Index, and the predictive variable was the Gambling Passion Scale. Multiple logistic regression analyses were conducted to identify independent risk factors of at-risk poker players 1 year later. Obsessive passion at baseline doubled the risk of gambling problems 1 year later (p

Aims To estimate the prevalence of cocaine binging and examine associated factors, to characterize binge episodes and to study the relationship between cocaine binging and HIV and HCV risk behaviors among street-based cocaine users. Methods A prospective cohort study was conducted in Montreal, Canada. Interviewer-administered questionnaire were carried out at 3-month intervals. Cocaine binging was defined as using large quantities of cocaine, without stopping, over a limited period of time, until resources run out or until being physically incapable of consuming. Generalized Estimation Equations (GEE) analyses were used. Covariates considered included demographic, behavioral, mental health and social risk factors. Findings In total, 605 participants were recruited. Prevalence of cocaine binging over the month prior to recruitment was 24.5%. Correlates of cocaine binging were older age (AOR 1.46), homelessness (AOR 1.44), criminal/marginal income strategies (AOR 1.61), high psychological distress (AOR 1.31), high cocaine dependence (AOR 3.71), drug overdoses (AOR 1.56) and smoking as the main route of cocaine administration (AOR 1.38). Additional GEE analyses showed that cocaine binging was significantly associated with the sharing of drug paraphernalia (AOR 1.35) and sexual relations under the influence of cocaine (AOR 1.21). Conclusion Cocaine binging is frequent among street-based cocaine users and is associated with markers of vulnerability. It is also associated with increased odds of both sexual and drug use risk behaviors. Interventions need to be tailored in order to help cocaine bingers develop personal strategies that could prevent binging. Harm reduction programs should help cocaine bingers adequately assess their drug equipment needs.

Previous research has shown that poker players spend significant time, large amounts of money and have a high prevalence of gambling problems. While some studies have examined the association between gambling behaviours and passion, none have explored this association specifically among poker players. This study aims to examine the relationships between two types of passion (i.e. harmonious and obsessive) and severity of gambling problems among poker players. A sample of 159 poker players was recruited from across Quebec, Canada. The outcome variable of interest was participants’ scores on the Canadian Pathological Gambling Index and the predictive variable was the Gambling Passion Scale. Multiple logistic regression analyses were conducted to identify independent risk factors of at-risk poker players. Severity of gambling problems is positively associated with obsessive passion (p < .05). However, harmonious passion is not associated with gambling problems. These results align with previous findi...

BACKGROUND: Opioid agonist treatment is considered important in preventing acquisition of hepatitis C virus (HCV) among people who inject drugs; however, the role of dosage in opioid agonist treatment is unclear. We investigated the joint association of prescribed dosage of opioid agonist treatment and patient-perceived dosage adequacy with risk of HCV infection among people who inject drugs. METHODS: We followed prospectively people who inject drugs at risk of acquiring HCV infection (who were RNA negative and HCV-antibody negative or positive) in Montreal, Canada (2004–2017). At 6-month, then 3-month intervals, participants were tested for HCV antibodies or RNA, and completed an interviewer-administered behavioural questionnaire, reporting the following: current exposure to opioid agonist treatment (yes/no), prescribed dosage either high (methadone ≥ 60 mg/d or buprenorphine ≥ 16 mg/d) or low, and perceived dosage adequacy (adequate/inadequate). We then assigned participants to 1 of 5 exposure categories: no opioid agonist treatment, high dosage of opioid agonist treatment perceived to be adequate, high dosage perceived to be inadequate, low dosage perceived to be adequate or low dosage perceived to be inadequate. To estimate associations between categories of opioid agonist treatment dosage and incident HCV infection, we conducted Cox regression analyses, adjusting for multiple confounding factors. RESULTS: Of 513 participants (median age 35.0 yr, 77.6% male), 168 acquired HCV over 1422.6 person-years of follow-up (incidence 11.8/100 person-years, 95% confidence interval [CI] 10.1–13.7). We observed a gradient in the relative risks of HCV infection across categories of opioid agonist treatment dosage. Compared with people who inject drugs not receiving opioid agonist treatment, adjusted hazard ratios were 0.43 (95% CI 0.23–0.84) for those receiving high dosages perceived to be adequate, 0.61 (95% CI 0.25–1.50) for those receiving high dosages perceived to be inadequate, 1.22 (95% CI 0.74–2.00) for those receiving low dosages perceived to be adequate and 1.94 (95% CI 1.11–3.39) for those receiving low dosages perceived to be inadequate. INTERPRETATION: Risk of HCV infection varies considerably according to dosage of opioid agonist treatment and patient-perceived adequacy, with associations indicating both protective and harmful effects relative to no exposure to opioid agonist treatment.

Hepatitis C virus (HCV) acquisition remains high in key risk environments including injection drug use and sex between men. However, few studies examine the independent contribution of sexual behaviour to HCV acquisition among people who inject drugs (PWID). We estimated HCV incidence and examined sexual behaviour as a time-varying predictor of HCV acquisition in a prospective cohort study of PWID in Montreal (2004-2017). Initially, HCV-negative participants completed behavioural questionnaires and HCV antibody testing (6 months until 2011, 3 months thereafter). A time-updating exposure variable (no sex, opposite-sex partner only, ≥1 same-sex partner) was generated for the previous 6/3 months. Time to HCV seroconversion was examined using Cox regression analysis, adjusted for age, unstable housing and incarceration (both past 3 months), and daily, heroin, cocaine and prescription opioid injecting (all past month). Among 440 PWID (baseline: median age 33 years, 18.9% female, 1.4% HIV-positive), 156 participants seroconverted during follow-up (overall incidence rate: 11.9/100 person-years [PY]). Incidence was lowest in the no sex group (8.70 and 2.91 cases/100 PY in males and females, respectively) and highest in the ≥1 same-sex partner group (24.14 and 21.97 cases/100 PY in males and females, respectively). Among males, HCV risk was 47% lower in those reporting no sex compared to ≥1 same-sex partner (adjusted hazard ratio: 0.53, 95% confidence interval: 0.28, 0.99). In this cohort of PWID, reporting recent same-sex partners was associated with greater risk of HCV acquisition among males, necessitating targeted harm reduction strategies that consider the complex interplay of sexual and injecting risk behaviours.

Introduction/Aim: Chronic non-cancer pain (CNCP) is both highly prevalent and undertreated among people who use illicit drugs (PWUD). To address the current opioid crisis, several health authorities have produced guidelines recommending not to prescribe opioid painkillers to patients with substance abuse risk factors. This could jeopardize pain relief for PWUD suffering from CNCP. This study aims to describe: (1) PWUD’s daily CNCP experiences; (2) barriers of access to adequate CNCP management for PWUD in the opioid crisis context; (3) PWUD’s stated needs for improving their CNCP and healthcare experiences. Methods: This was a qualitative study. In-depth semi-structured interviews were conducted with 25 PWUD (illicit opioids and/or cocaine) suffering from CNCP (≥ 3 months) recruited in downtown Montreal (2017/07 to 2018/05). Interviews were analyzed using Grounded Theory method. Results: Participants faced multiple health problems (e.g. HIV, hepatitis C) and social issues (e.g. homelessness, precarious employment) concomitantly with CNCP and substance use. These problems contributed to heighten their pain intensity. Physicians’ increased defiance against PWUD in the opioid crisis context led to major barriers for participants’ pain management. Participants experienced stigma and discrimination in the healthcare system. They wished they could access non-pharmacological therapies (e.g. physiotherapy) as alternatives to opioids, but these therapies were unaffordable. Some participants reported self-medicating their CNCP with street drugs when no other solution was available. Discussion/Conclusions: PWUD suffering from CNCP are a population with several comorbidities and high health care needs. Public policies should be revisited to improve access to appropriate CNCP management for this population.

Despite the popularity in poker-related activities in recent years, few studies have focused on the evolution of gambling habits of poker players over a long period of time. The aim of this study is to examine factors influencing trajectories of poker players. The results are based on data collected at a four-time measurement of a prospective cohort study conducted in Quebec (n = 304 poker players). A latent class growth analysis was performed to identify trajectories based on the Problem Gambling Severity Index score. Multinomial multivariable logistic regression analyses were conducted to determine the correlates of gambling trajectories. Over the 3 years of the study, three gambling problem trajectories were identified, comprising one decreasing trajectory (1st: non-problematic—diminishing), one stable trajectory (2nd: low risk—stable), and one increasing trajectory (3th: problem gamblers—increasing). Internet as the main poker form and number of game played were associated with at-risk trajectories. Depression symptoms were significant predictors of the third trajectory whereas impulsivity predicted the second trajectory. This study shows that the risk is remaining low over years for the vast majority of poker players. However, the vulnerable poker players at the beginning of the study remain on a problematic increasing trajectory. It is therefore important to prioritize individuals in the third trajectory for interventions.

AIMS To examine temporal trends in prescription opioid (PO) injection and to assess its association with hepatitis C virus (HCV) seroconversion among people who inject drugs (PWID). DESIGN Prospective cohort study spanning 2004 to 2016. SETTING Montreal, Canada. PARTICIPANTS PWID reporting injection during the past 6 months. MEASUREMENTS PWID were recruited between 2004 and 2016. At each 3-6-month follow-up visit, participants completed interview-administered questionnaires and were tested for HCV-antibody. FINDINGS Among 1524 PWID [83% males, mean age 38 years, standard deviation (SD) = 10, 34% (31-36) prescription opioid (PO) injection past month] included in trends analyses, PO injection use expanded between 2004 and 2009, and plateaued between 2010 and 2016 (trend tests

Summary Background People who inject drugs (PWID) experience a high prevalence of incarceration and might be at high risk of HIV and hepatitis C virus (HCV) infection during or after incarceration. We aimed to assess whether incarceration history elevates HIV or HCV acquisition risk among PWID. Methods In this systematic review and meta-analysis, we searched MEDLINE, Embase, and PsycINFO databases for studies in any language published from Jan 1, 2000 until June 13, 2017 assessing HIV or HCV incidence among PWID. We included studies that measured HIV or HCV incidence among community-recruited PWID. We included only studies reporting original results and excluded studies that evaluated incident infections by self-report. We contacted authors of cohort studies that met the inclusion or exclusion criteria, but that did not report on the outcomes of interest, to request data. We extracted and pooled data from the included studies using random-effects meta-analyses to quantify the associations between recent (past 3, 6, or 12 months or since last follow-up) or past incarceration and HIV or HCV acquisition (primary infection or reinfection) risk among PWID. We assessed the risk of bias of included studies using the Newcastle-Ottawa Scale. Between-study heterogeneity was evaluated using the I 2 statistic and the P-value for heterogeneity. Findings We included published results from 20 studies and unpublished results from 21 studies. These studies originated from Australasia, western and eastern Europe, North and Latin America, and east and southeast Asia. Recent incarceration was associated with an 81% (relative risk [RR] 1·81, 95% CI 1·40–2·34) increase in HIV acquisition risk, with moderate heterogeneity between studies ( I 2 =63·5%; p=0·001), and a 62% (RR 1·62, 95% CI 1·28–2·05) increase in HCV acquisition risk, also with moderate heterogeneity between studies ( I 2 =57·3%; p=0·002). Past incarceration was associated with a 25% increase in HIV (RR 1·25, 95% CI 0·94–1·65) and a 21% increase in HCV (1·21, 1·02–1·43) acquisition risk. Interpretation Incarceration is associated with substantial short-term increases in HIV and HCV acquisition risk among PWID and could be a significant driver of HCV and HIV transmission among PWID. These findings support the need for developing novel interventions to minimise the risk of HCV and HIV acquisition, including addressing structural risks associated with drug laws and excessive incarceration of PWID. Funding Engineering and Physical Sciences Research Council, National Institute for Health Research, National Institutes of Health.

Background:Canada leads in opioid prescription and consumption rates, and this has resulted in high levels of opioid-related morbidity and mortality. Pharmacists’ input could contribute significantly to understanding the disadvantages of opioid prescribing and dispensing and improving the service. This study aimed to examine the experiences of community pharmacists in relation to opioid prescribing and dispensing, with a focus on optimizing collaboration and communication.Methods:An online survey was performed among pharmacists from the province of Quebec, Canada, in 2016. Pharmacists were eligible if registered and working in community pharmacies.Results:In all, 542 questionnaires were analyzed (participation rate of 8.1%). Pharmacotherapy-related problems were reported in at least 50% of opioid prescriptions: additional drug(s) required (reported by 30% of pharmacists), interaction(s) between opioid(s) and other drug(s) (16%), physician did not meet the general issuing standards for opioid prescriptions (26%) and patient had mild to moderate pain that was easily managed by a nonopioid analgesic (20%). Half of the patients were reported as requesting anticipated refills, possibly indicating abuse or poor pain control. Most pharmacists (89.6%) reported needing to contact physicians in 1 to 3 out of 10 opioid prescriptions, but many pharmacists (71.8%, often or very often) reported difficulties communicating with physicians.Conclusions:Pharmacists’ observations of pharmacotherapy-related problems and patients’ unusual behaviours reveal a significant number of issues related to opioid prescribing and dispensing in an outpatient setting. Improved collaboration between physicians and pharmacists appears mandatory to address the issues reported in this study.

BACKGROUND AND AIMS Prescription opioid injection (POI) is a leading risk factor for hepatitis C virus (HCV). Residential context relates to high‐risk injection behaviour. This study assessed whether residence in the inner city (versus surrounding areas in Montreal Island) modified the effects of correlates of POI or the relationship between POI and HCV incidence. DESIGN Prospective cohort study. SETTING Montreal, Canada. PARTICIPANTS A total of 854 people who inject drugs (18% female, 25% age < 30 years), living on Montreal Island, were interviewed every 3–6 months from 2004 to 2012. MEASUREMENTS Study visits included HCV antibody testing and an interviewer‐administered questionnaire. Generalized estimating equations were used to test whether place of residence modified the effects of correlates of POI. Cox regression was used to test whether place of residence modified the relationship between POI and HCV incidence. FINDINGS At baseline, inner‐city participants were more likely to report POI in the past month (40 versus 25%, P < 0.001). The association between POI and heroin injection, syringe sharing and sharing of injecting equipment varied according to place of residence and was greater in the inner city. The hazard of HCV infection associated with POI was greater among inner‐city participants compared to those in the surrounding areas [adjusted hazard ratio (HR) = 3.38, 95% confidence interval (CI) = 1.88–6.07 versus HR = 1.26, 95% CI = 0.65–2.42, P = 0.025]. CONCLUSIONS Among people who inject prescription opioids in Montreal, Canada, those who live in inner‐city areas are more likely to engage in injecting‐related risk behaviours and have a higher risk of hepatitis C virus infection than those who live in the suburbs.

After more than 30 years of research, numerous studies have shown that injection drug use is associated with a wide range of adverse health outcomes such as drug overdoses, drug-related suicidal behaviours, comorbid psychiatric disorders, bloodborne pathogens and other infectious diseases, and traumas. This review explores new trends and prominent issues associated with injection drug use. The dynamic nature of injection drug use is underlined by examining its recent trends and changing patterns in Canada and other “high-income countries.” Three research topics that could further contribute to the development of comprehensive prevention and intervention strategies aimed at people who inject drugs are also discussed: risk behaviours associated with the injection of prescription opioids, binge injection drug use, and mental health problems as determinants of injection risk behaviours.

The current opioid crisis in North America has strengthened the boundary between "genuine chronic pain patients" and "drug addicts," though these categories are not mutually exclusive. Despite its high prevalence -more than double the general population rate- chronic pain among people who use illicit drugs (PWUD) remains an overlooked issue in both health and social sciences. Using the theoretical framework of sociology of illness experience, the aim of this qualitative study was to understand how the experience of illicit drug use shapes the chronic pain experience. We conducted in-depth interviews with 25 individuals who used street opioids and/or cocaine (with or without any other drug) and had suffered from chronic pain for three months or more. Participants were recruited from July 2017 to May 2018, in Montreal (Canada). Social deprivation and drug use increased PWUD's exposure to a wide range of health issues including chronic pain. Even when intense, pain was often described as peripheral in their life given their many other problems. They experienced double stigmatization due to the cumulation of two socially devalued statuses, "drug addicts" and "chronic pain sufferers." Their attempts to avoid stigma included valuing their toughness/endurance and pursuing physical activities despite the pain. Some reported using substances like cocaine or heroin to meet social expectations of performance regardless of pain. This study improves the knowledge on illness experiences within deprived social settings by showing how marginalization and stigma render PWUD's pain clinically and socially invisible.

Background The relationship between housing stability and drug injecting is complex, as both outcomes fluctuate over time. The objectives were to identify short-term trajectories of housing stability and injecting frequency among people who inject drugs (PWID) and examine how patterns of injecting frequency relate to those of housing stability. Methods At three-month intervals, PWID enrolled between 2011 and 2016 in the Hepatitis Cohort completed an interviewer-administered questionnaire and were tested for hepatitis C and HIV infections. At each visit, participants reported, for each of the past three months, the accommodation they lived in the longest (stable/unstable) and the number of injecting days (0–30). Group-based dual trajectory modeling was conducted to identify housing stability and injecting frequency trajectories evolving concomitantly over 12 months and estimate the probabilities of following injecting trajectories conditional upon housing trajectories. Results 386 participants were included (mean age 40.0, 82 % male). Three housing stability trajectories were identified: sustained (53 %), declining (20 %), and improving (27 %). Five injecting frequency trajectories were identified: sporadic (26 %), infrequent (34 %), increasing (15 %), decreasing (11 %), and frequent (13 %). PWID with improving housing were less likely to increase injecting (8 %) compared to those with sustained (17 %) or declining housing (17 %). Conclusions Improving housing was associated with a lower probability of increasing injecting compared to declining housing, while sustained housing stability was associated with a higher probability of increasing injecting compared to improving housing. Therefore, policies to improve PWID’s access to stable housing are warranted and may reduce, to some extent, drug injecting and related harms.

BACKGROUND AND AIMS For most people who inject drugs (PWID), drug injecting follows a dynamic process characterized by transitions in and out of injecting. The objective of this investigation was to examine injecting cessation episodes of 1-3-month duration as predictors of hepatitis C virus (HCV) acquisition. DESIGN Cohort study. SETTING Montreal, Canada. PARTICIPANTS A total of 372 HCV-uninfected (HCV RNA-negative, HCV antibody-positive or -negative) PWID (mean age = 39.3 years, 82% male, 45% HCV antibody-positive) enrolled between March 2011 and June 2016. MEASUREMENTS At 3-month intervals, participants completed an interviewer-administered questionnaire and were tested for HCV particles (HCV RNA). At each visit, participants indicated whether they injected in each of the past 3 months (defined as three consecutive 30-day periods). Injecting cessation patterns were evaluated on a categorical scale: persistent injecting (no injecting cessation in the past 3 months), sporadic injecting cessation (injecting cessation in 1 of 3 or 2 of 3 months) and short injecting cessation (injecting cessation in 3 of 3 months). Their association with HCV infection risk was examined using Cox regression analyses with time-dependent covariates, including age, gender, incarceration, opioid agonist treatment and other addiction treatments. FINDINGS At baseline, 61, 26 and 13% of participants reported persistent injecting, sporadic injecting cessation and short injecting cessation, respectively. HCV incidence was 7.5 per 100 person-years [95% confidence interval (CI) = 5.9-9.5; 916 person-years of follow-up]. In adjusted Cox models, sporadic injecting cessation and short injecting cessation were associated with lower risks of incident HCV infection compared to persistent injecting (adjusted hazard ratios = 0.56, 95% CI = 0.30-1.04 and 0.24, 95% CI = 0.09-0.61), respectively. CONCLUSION Short and sporadic injecting cessation episodes were common among a cohort of people who inject drugs in Montreal, Canada. Injecting cessation episodes appear to be protective against hepatitis C virus acquisition, particularly when maintained for at least 3 months.

BACKGROUND: In Canada, the majority of new and existing cases of hepatitis C virus (HCV) infection occur among people who inject drugs (PWID), mostly through receptive sharing of injection material. Injecting drug use has been shown to be a dynamic process characterized by transitions in and out of injection. We have previously shown that short injection cessations are associated with a reduced risk of receptive sharing of injection material when resuming injection. AIMS: This investigation aimed to assess the association between HCV infection and intermittent injecting drug use, when considering one-month injection cessation episodes. METHODS: The HEPCO study is an observational cohort of PWID recruited and followed longitudinally in Montréal (QC). At 3-month intervals, uninfected participants (HCV RNA-negative) enrolled between March 2011 and December 2014 were tested for HCV, and completed an interviewer-administered questionnaire eliciting information on sociodemographics, drug use, and related behaviors and treatments. Participants were at-risk of either primary HCV infection (anti-HCV-negative participants), or reinfection/recurrence (anti-HCV-positive participants). Injecting drug use in the past 3 months was categorized as follows: injecting within 0 (no use), 1 or 2 (intermittent use), or 3 months (continuous use). HCV infection was estimated to occur at the midpoint between two visits. Cox regression analyses with time-dependent covariates were performed, and Kaplan–Meier failure curves for multiple-record-per-subject data were estimated. RESULTS: 311 participants with ≥1 follow-up visit (mean age 40 years, 82% male, 47% anti-HCV positive) contributed 1,689 visits. HCV incidence was 11.3 per 100 person-years [95% confidence interval (CI), 8.8–14.4]. At baseline, 188 (60%), 79 (25%) and 44 (14%) participants reported continuous, intermittent and no injecting drug use in the past 3 months, respectively. In univariate Cox models, intermittent and no injecting drug use were significantly associated with a reduced risk of HCV infection [intermittent use: hazard ratio (HR) 0.36, 95%CI 0.17–0.77; no use: HR 0.23, 95%CI 0.09–0.58] compared to continuous use. In models adjusted for age, gender and opioid substitution treatment, associations remained statistically significant for both intermittent (HR 0.40, 95%CI 0.19–0.86) and no injecting drug use (HR 0.30, 95%CI 0.12–0.77). There was no evidence of effect modification by anti-HCV status at baseline. CONCLUSIONS: Intermittent injecting drug use was associated with a reduced risk of HCV infection. Findings bring new perspectives regarding injecting profiles and their relation to HCV risk, and for improving PWID’s access to clinical care and harm reduction interventions. Further work is needed to contextualize intermittent injecting drug use in the injecting drug use trajectory. FUNDING AGENCIES: CIHRFRQS

La passion est étudiée depuis une quinzaine d’années chez les joueurs de jeu de hasard et d’argent. Elle comprend deux formes, soit la passion obsessive (PO) qui est contrôlante et la passion harmonieuse (PH) qui laisse de la place à d’autres activités du joueur. Les études transversales associent la PO aux problèmes de jeu, ce qui n’est pas le cas de la PH. Toutefois, la pertinence de l’utilisation du concept de passion et son influence sur les comportements de jeu, selon le discours des joueurs, sont totalement méconnues. Les objectifs de cette étude étaient d’examiner la pertinence du concept de passion chez des joueurs poker (JdP) et de comprendre les liens entre les deux formes de passion et les problèmes de jeu. Cette étude qualitative descriptive est la deuxième composante d’une étude mixte séquentielle auprès de JdP du Québec (n=12). L’analyse de contenu thématique a été réalisée en privilégiant la thématisation en continu. Parmi les participants, la majorité a été ou est actuellement passionnée de poker et les deux formes de passion sont des concepts pertinents selon les joueurs. Le fait d’être passionné serait l’un des facteurs influençant les comportements de jeu. Toutefois, un JdP peut continuer à jouer sans être passionné alors que l’on peut également être passionné sans nécessairement jouer fréquemment. Il ne semble donc pas y avoir de lien direct entre la passion et la fréquence de jeu. La pertinence du concept de passion pour les joueurs permet de penser qu’il pourrait être utilisé en prévention ou encore dans le traitement des JdP.Abstract Passion among gamblers has been studied for the last decade and a half. There are two forms of passion: obsessive passion (OP), which is controlling, and harmonious passion (HP), which leaves room for the gambler’s other activities. Cross-sectional studies associate OP with gambling problems, which is not the case for HP. The relevance of the concept of passion and passion’s influence on gambling behaviour are, however, uncertain, according to gamblers themselves. The objectives of this study were to examine the relevance of the concept of passion for poker players (PP) and understand the connections between the two forms of passion and gambling problems. This qualitative descriptive study is the second part of a sequential mixed study with PPs in Québec (n=12). The thematic content analysis was conducted using continuous thematization. The majority of the participants were or are currently passionate about poker, and both forms of passion are relevant concepts for these players. According to them, being passionate is one of the behaviours that influences gambling behaviour. A PP may, however, continue to play without being passionate, but also be passionate without necessarily playing frequently. There does not, therefore, seem to be any direct connection between passion and frequency of play. The relevance of the concept of passion for poker players suggests that it may be used preventively or in the treatment of PPs.

ObjectivesThe objectives of this study were: (1) to examine the correlates of HIV positivity among participants who injected drugs and engaged in sex work (PWID-SWs) in the SurvUDI network between 2004 and 2016, after stratification by sex, and (2) to compare these correlates with those of sexually active participants who did not engage in sex work (PWID non-SWs).Design and settingThis biobehavioural survey is an open cohort of services where participants who had injected in the past 6 months were recruited mainly through harm reduction programmes in Eastern Central Canada.ParticipantsData from 5476 participants (9223 visits in total; 785 not included in multivariate analyses due to missing values) were included.MethodsParticipants completed an interviewer-administered questionnaire and provided saliva samples for anti-HIV antibody testing. Generalised estimating equations taking into account multiple participations were used.ResultsBaseline HIV prevalence was higher among SWs compared with non-SWs (women: 13.0% vs 7.7%; PConclusionThese results suggest that sex work has an impact on the risk of HIV acquisition and that risk behaviours vary according to gender. Public health practitioners should take those specificities into account when designing HIV prevention interventions aimed at PWIDs.

Background: People who inject drugs (PWID) have an elevated risk of suicide attempt. Although different substances are associated with suicide attempt, the overall risk posed by binge behavior, a high-risk pattern of drug use, remains unclear. The objective of this study is to assess the association between binge drug use and suicide attempt in a prospective cohort of PWID in Montreal, Canada. Methods: Participants answered a biannual interviewer-administered questionnaire compiling information on sociodemographics, pattern of substance use (cocaine, amphetamine, opioids, sedative-hypnotics, alcohol, and cannabis), and psychosocial stressors and related markers. The relationship between suicide attempt and binge behavior was modeled using generalized estimating equations (GEEs), controlling for type and pattern of substance use, sociodemographic characteristics, and significant mental health markers. Results: Among 1240 participants (mean age ± SD: 38.2 ± 9.8) at baseline, 222 (17.9%) reported binge during the past 6–months. PWID reporting binge were significantly younger ( P < .001), less educated ( P = .012), less likely male ( P = .047), and had shorter history of injection ( P < .001). In addition, they were younger at first injection ( P = .014), reported higher rates of prostitution and psychological disorders ( P = .003), and were more likely to use other drugs except cannabis and alcohol. Binge was independently associated with attempted suicide in the GEE multivariate model (adjusted odds ratio [aOR 95% CI] = 1.91 [1.38–2.65], P < .001). Conclusions: Among PWID at high risk of suicide attempt, those who binge represent a particularly vulnerable subgroup. Although the exact mechanisms underlying this finding remain unresolved, several hypothesis pertaining to the neurobiological and psychosocial consequences of binge, as well as common personality traits, warrant further investigations.

Background and Objectives Despite being common among cocaine users, mental health problems and their relationship with HIV and hepatitis C high risk injection behaviors are poorly documented. This study was undertaken to examine the relationships between mood and anxiety disorders and the sharing of drug injection equipment among cocaine users who inject drugs. Methods The sample was drawn from a prospective cohort study and comprised of 387 participants. The outcome of interest was “sharing injection material” in the past 3 months. The presence of mood and anxiety disorders during the past year was assessed using the CIDI questionnaire. Statistical analyses were conducted on baseline data using logistic regression. Results Most participants were male (84.5%) and were aged 25 or over (92.2%); 43.0% qualified for an anxiety disorder diagnosis and 29.3% for a mood disorder diagnosis. Participants with anxiety disorders were more likely to share needles (Adjusted Odds Ratio [AOR]: 2.13, 95%CI: 1.15–3.96) and other injection material (AOR: 1.81, 95%CI: 1.12–2.92). No significant association was found between mood disorders and sharing behaviors. Discussion and Conclusions Primary anxiety disorders but not mood disorders increases injection risk behaviors among cocaine users. These results bring to light another negative outcome of mental health comorbidity in this vulnerable population. Scientific Significance This study underlines the need to fine-tune therapeutic approaches targeting specific mental health problems in individuals with cocaine use disorders. Longitudinal studies that assess impulsivity and other correlates of psychiatric disorders are needed to examine underlying mechanisms of high risk injection behaviors in comorbid populations. (Am J Addict 2015;XX:1–7)

AIM: To estimate associations between recent licit and illicit substance use and subsequent suicide attempt among people who inject drugs (PWID). DESIGN: Secondary analysis of longitudinal data from a prospective cohort study of PWID followed bi-annually between 2004 and 2011. SETTING: Montreal, Canada. PARTICIPANTS: Seven-hundred and ninety-seven PWID who reported injection drug use in the previous six months, contributing to a total of 4,460 study visits. The median number of visits per participant was 5 (Interquartile range: 3-8). MEASUREMENTS: An interviewer-administered questionnaire eliciting information on socio-demographic factors, detailed information on substance use patterns and related behaviours, mental health markers and suicide attempt. The primary exposure variables examined were past-month use of alcohol [heavy ((3) 60 drinks); moderate (1-59 drinks); none], sedative-hypnotics, cannabis, cocaine, amphetamine and opioids [regular ((3) 4 days); occasional (1-3 days); none]. The outcome was a binary measure of suicide attempt assessed in reference to the previous six months. FINDINGS: In multivariate analyses, among licit substances, a positive association was found between heavy alcohol consumption [adjusted odds ratio (AOR): 2.05; 95% confidence interval (CI): 1.12-3.75], regular use of sedative-hypnotics (AOR: 1.89; 95% CI: 1.21-2.95) and subsequent attempted suicide. Among illicit substances, occasional use of cannabis (AOR: 1.84; 95% CI: 1.09-3.13) had a positive association with subsequent suicide attempt. No statistically significant association was found for the remaining substances. CONCLUSION: Among people who inject drugs, use of alcohol, sedative-hypnotics and cannabis, but not cocaine, amphetamine or opioids, appears to be associated with increased likelihood of later attempted suicide. This article is protected by copyright. All rights reserved. Language: en

Aim We tested the efficacy of a brief intervention based on motivational interviewing (MI) to reduce high-risk injection behaviours over a 6-month period among people who inject drugs (PWID). Design A single-site two-group parallel randomized controlled trial comparing MI with a brief educational intervention (EI). Setting A study office located in downtown Montreal, Canada, close to the community-based harm reduction programmes where PWID were recruited. Participants PWID who had shared drug injection equipment or shared drugs by backloading or frontloading in the month prior to recruitment were randomized to either the MI (112) or EI (109) groups. Intervention The MI aimed to (1) encourage PWID to voice their desires, needs and reasons to change behaviours; (2) boost motivation to change behaviours; and (3) when the person was ready, support the plan he or she chose to reduce injection risk behaviours. The EI consisted of an individual session about safe injection behaviours. Measurements The primary outcome was defined as having any of these risk behaviours at 6 months: having shared syringes, containers, filters or water to inject drugs in the previous month and backloading/frontloading; each behaviour was examined separately, as secondary outcomes. Findings The probability of reporting a risk injection behaviour decreased in both the MI and the EI groups. At 6-month follow-up, participants who reported any risk behaviours were 50% [odds ratio (OR) = 0.50; confidence interval (CI) = 0.13–0.87] less likely to be in the MI group than in the EI group as well as those who reported sharing containers (OR = 0.50; CI = 0.09–0.90). PWID who reported sharing equipment excluding syringes were 53% less likely to be in the MI group (OR = 0.47; CI = 0.11–0.84). Conclusions A brief motivational interviewing intervention was more effective than a brief educational intervention in reducing some high risk injecting behaviours up in the subsequent 6 months.

Tranquilizer use is associated with negative health outcomes among people who use drugs. This paper aims to estimate the incidence rate (initiation) and identify predictors of tranquilizer misuse (TM) among cocaine users.A prospective cohort study was conducted in Montreal, Canada. Interviewer-administered questionnaires were carried out at 3-month intervals. Initiation was defined as misusing a tranquilizer for the first time during follow-up. 'Lasting-initiation', defined as reporting TM at the next visit following first use, was also examined. Cox proportional hazard regression analyses were carried out to assess predictors of initiation to TM.Among the 245 participants who were eligible for the initiation analyses, 123 started TM during follow-up for an incidence rate of 40.49 per 100 person-years (95% confidence interval, CI: 33.80-48.15). Of the 123 initiates, 35.7% were still using at the interview following initiation for an incidence rate of 14.70 per 100 person-years (95% CI: 10.82-19.56). Multivariate models showed that independent predictors of initiation and 'lasting initiation' were identical as having had a criminal activity as the main source of income, having been recently in treatment for a substance use disorder (SUD) and reporting non-medical use of prescription opioids.The incidence rate of TM initiation was high among a sample of cocaine users. Initiation was predicted by a problematic drug use pattern involving polydrug use, involvement in the street economy and having been in treatment for a SUD. These findings have implications for prevention and harm reduction strategies.

Background HCV transmission remains high in people who inject drugs (PWID) in Montréal. New direct-acting antivirals (DAAs), highly effective and more tolerable than previous regimens, make a “Treatment as Prevention” (TasP) strategy more feasible. This study assesses how improvements in the cascade of care could impact hepatitis C burden among PWID in Montréal. Methods We used a dynamic model to simulate HCV incidence and prevalence after 10 years, and cirrhosis complications after 10 and 40 years. Eight scenarios of improved cascade of care were examined. Results Using a baseline incidence and prevalence of 22.1/100 person-years (PY) and 53.1%, implementing the current cascade of care using DAAs would lead to HCV incidence and prevalence estimates at 10 years of 9.4/100PY and 55.8%, respectively. Increasing the treatment initiation rate from 5%/year initially to 20%/year resulted in large decreases in incidence (6.4/100PY), prevalence (36.6%), and cirrhosis complications (−18%/-37% after 10/40 years). When restricting treatment to fibrosis level ≥ F2 instead of F0 (reference scenario), such decreases in HCV occurrence were unreachable. Improving the whole cascade of care led to the greatest effect by halving both the incidence and prevalence at 10 years, and the number of cirrhosis complications after 40 years. Conclusions The current level of treatment access in Montréal is limiting a massive decrease in hepatitis C burden among PWID. A substantial treatment scale-up, regardless of fibrosis level, is necessary. While improving the rest of the cascade of care is necessary to optimize a TasP strategy and control the HCV epidemic, a treatment scale-up is first needed. Electronic supplementary material The online version of this article (doi:10.1186/s12879-017-2256-5) contains supplementary material, which is available to authorized users.