addic%on-related characteris%cs of substance users in harm ... · addic%on-related characteris%cs...

Addic%on-related characteris%cs of substance users in harm reduc%on programs: a systema%c review METHODS C. Kervran, F. Serre, C. Denis, S. Moriceau, M. Fatséas, P. Roux, M. Jauffret-Rous<de, L. Lalanne, J.P. Daulouède, M. Auriacombe INTRODUCTION Harm reduction policy adopted to face HIV epidemic among people who inject drugs (PWID) have improved access of prevention and care but: - high prevalence of HCV was found and maintenance of frequent risk behaviors ! need to increase harm reduc<on program efficiency - harm reduc<on programs users are oOen in excessive and problema<c use, with many risk-prac<ces and vulnerabili<es, - what extent their use is driven by addic<on, craving, or other poten<al causali<es ? - problema<c substance users who aQend harm reduc<on programs have not been fully studied from the perspec<ve of characterizing substance use disorder, diagnos<c criteria endorsed, and the role of craving in their use OBJECTIVE The objec<ve of this literature review was to evaluate addic<on-related characteris<cs of problema<c substance users in harm reduc<on programs on: - prevalence of substance use disorder (SUD) diagnoses - craving prevalence and intensity Contacts : [email protected] [email protected] Financial Support: French Government Addic<on Agency MILDECA Systema<c review of the literature: PubMed database Criteria for considering studies - Types of studies: included problema<c substance users outside addic<on treatment facili<es, substance users aQending Needle Exchange Programs, Supervised Injec<ng Facili<es, harm reduc<on programs - Types of par%cipants: included subjects repor<ng any substance use Search method and selec<on of studies Terms ((((((((("Supervised") OR "safer")) AND (((("injec<on") OR "injec<ng") OR "shoo<ng") OR "consump<on")) AND ((((((facility) OR facili<es) OR room) OR gallery) OR center) OR site))) OR "Needle- Exchange Programs"[Mesh]) OR Harm reduc<on)) were combined with the terms ((("Mental Disorders/diagnosis"[Mesh]) OR "Craving"[Mesh]) OR craving) Records iden<fied through database searching (n=254) Addi<onal records iden<fied through other sources (n=8) Abstracts screened 262 publica<ons Manual pre-screening on <tle and abstract 35 publica<ons Studies included in the review 12 publica<ons 228 excluded 23 excluded RESULTS Search results 9 publica<ons examined the diagnosis of SUD and 3 craving Characteris<cs of samples - n= 1852 different par<cipants Samples size : range 80-570 - Studies included adult or young adults - Majority of males (60% to 72.8%) Substance Use Disorder diagnoses - 2 publica<ons used the DSM-IIIR and 7 used the DSM-IV Opiates 100% Cocaïne 16%-79% Alcohol 15%-69% Cannabis 6%-51% Seda<ve 4%-13% Hallucinog en 1%-13% S<mulant 2%-11% Frequency and intensity of craving - 2 publica<ons showed the implica<on of craving in at-risk prac<ces :probability of sharing increased as craving increased CONCLUSION • In this review, high prevalence of SUD diagnosis and poly-addic<on suggested that excess of use is mo<vated by a loss of control, a core characteris<c of addic<on, and not a voluntary use without addic<on • Few studies have assessed craving, and study limita<ons make results interpreta<on difficult • However, it seems that among NEP users, craving was associated with HIV risk prac%ces, that highlights the need of taking into account craving in harm reduc<on efforts • The lack of data on substance use disorder diagnos<c criteria and craving characteris<cs among users of NEP may be an important omission in efforts to enhance the individual and public health benefits of harm reduc<on programs 0 2 4 6 8 Number of studies Prevalence of SUD (9 studies): Moderate or severe 57% Not at all or slight 43% Craving - Poly-substances 37% to 44% - average of 3.3 life<mes SUD and 1.3 current SUD

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Page 1: Addic%on-related characteris%cs of substance users in harm ... · Addic%on-related characteris%cs of substance users in harm reducon programs: a systemac review METHODS C. Kervran,

Addic%on-relatedcharacteris%csofsubstanceusersinharmreduc%onprograms:asystema%creview

METHODS

C.Kervran,F.Serre,C.Denis,S.Moriceau,M.Fatséas,P.Roux,M.Jauffret-Rous<de,L.Lalanne,J.P.Daulouède,M.Auriacombe

INTR

ODU

CTION Harm reduction policy adopted to face HIV epidemic among people who inject drugs (PWID) have improved

access of prevention and care but: -  high prevalence of HCV was found and maintenance of frequent risk behaviors! need to increase harm reduc<onprogramefficiency

-  harmreduc<onprogramsusersareoOeninexcessiveandproblema<cuse,withmanyrisk-prac<cesandvulnerabili<es,-  whatextenttheiruseisdrivenbyaddic<on,craving,orotherpoten<alcausali<es?-  problema<c substanceuserswhoaQendharm reduc<onprogramshavenotbeen fully studied from theperspec<veofcharacterizingsubstanceusedisorder,diagnos<ccriteriaendorsed,andtheroleofcravingintheiruse

OBJEC

TIVE

The objec<ve of this literature review was to evaluate addic<on-related characteris<cs of problema<csubstanceusersinharmreduc<onprogramson:-  prevalenceofsubstanceusedisorder(SUD)diagnoses-  cravingprevalenceandintensity

Contacts:[email protected]@u-bordeaux.fr

FinancialSupport:FrenchGovernmentAddic<onAgencyMILDECA

Systema<creviewoftheliterature:PubMeddatabaseCriteriaforconsideringstudies-Typesofstudies:includedproblema<csubstanceusersoutsideaddic<ontreatmentfacili<es,substanceusersaQendingNeedleExchangePrograms,SupervisedInjec<ngFacili<es,harmreduc<onprograms-  Typesofpar%cipants:includedsubjectsrepor<nganysubstanceuse

Searchmethodandselec<onofstudiesTerms ((((((((("Supervised") OR "safer")) AND (((("injec<on") OR"injec<ng") OR "shoo<ng") OR "consump<on")) AND ((((((facility) ORfacili<es) OR room) OR gallery) OR center) OR site))) OR "Needle-Exchange Programs"[Mesh]) OR Harm reduc<on)) were combined withthe terms ((("Mental Disorders/diagnosis"[Mesh]) OR "Craving"[Mesh])ORcraving)

Recordsiden<fiedthroughdatabasesearching(n=254)

Addi<onalrecordsiden<fiedthroughothersources(n=8)

Abstractsscreened262publica<ons

Manualpre-screeningon<tleandabstract

35publica<ons

Studiesincludedinthereview12publica<ons

228excluded

23excluded

RESULTSSearchresults9publica<onsexaminedthediagnosisofSUDand3cravingCharacteris<csofsamples-  n=1852differentpar<cipantsSamplessize:range80-570-  Studiesincludedadultoryoungadults-  Majorityofmales(60%to72.8%)SubstanceUseDisorderdiagnoses-  2publica<onsusedtheDSM-IIIRand7usedtheDSM-IV

Opiates100%

Cocaïne16%-79%

Alcohol15%-69%

Cannabis6%-51%Seda<ve4%-13%

Hallucinogen1%-13%

S<mulant2%-11%

Frequencyandintensityofcraving-  2publica<onsshowedtheimplica<onof

cravinginat-riskprac<ces:probabilityofsharingincreasedascravingincreased

CONCLUSION •  Inthisreview,highprevalenceofSUDdiagnosisandpoly-addic<onsuggestedthatexcessofuseismo<vatedbyalossof

control,acorecharacteris<cofaddic<on,andnotavoluntaryusewithoutaddic<on•  Fewstudieshaveassessedcraving,andstudylimita<onsmakeresultsinterpreta<ondifficult•  However,itseemsthatamongNEPusers,cravingwasassociatedwithHIVriskprac%ces,thathighlightstheneedoftaking

intoaccountcravinginharmreduc<onefforts•  Thelackofdataonsubstanceusedisorderdiagnos<ccriteriaandcravingcharacteris<csamongusersofNEPmaybean

importantomissionineffortstoenhancetheindividualandpublichealthbenefitsofharmreduc<onprograms

0 2 4 6 8

Numberofstudies PrevalenceofSUD(9studies):

Moderateorsevere

57%

Notatallorslight43%

Craving

-Poly-substances37%to44%-averageof3.3life<mesSUDand1.3currentSUD

Wmsbg 2012 Older Adults Addic

sa04c6dbaa013e929.jimcontent.com...Vll harm. 12 111 harm. 12 111 harm. 12 18 to Coda Vll rit. Vll 2nd time D.S. al Coda harm. 12 Coda 111 harm. 12 3 Music computer typeset by Seton

Alcohol Harm Reduction Compared To Harm Reduction For Other Drugs Kenneth Anderson The HAMS Harm Reduction Network