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

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:charloQe.kervran@u-bordeaux.frmarc.auriacombe@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