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