Overdose prevention in injecting opioid users: The role of substance abuse treatment and training programs / La prevención de sobredosis en usuarios de opioides por vía parenteral: el papel del tratamiento y de los talleres de prevención

Objectives: Opioid overdose is still the first cause of preventable death among young men in Barcelona. Sound knowledge of opioid overdose prevention is important to avoid complications and deaths. This study aimed to identify the factors associated with limited knowledge of overdose prevention and to assess the possible effect of treatment and overdose prevention training programs on this variable. Methods From October 2008 to March 2009, current injecting opioid users attending harm reduction centers in Catalonia (Spain) were interviewed. Crude and adjusted prevalence ratios of limited knowledge about overdose prevention were calculated by adjusting Poisson regression models with a robust variance. Results In this sample, 28.7% of clients had limited knowledge of overdose prevention. Factors associated with limited knowledge were country of origin, never having received treatment for drug dependency, having a low educational level, and never having experienced an overdose. In contrast, treatment at the time of the interview was not associated with a lower prevalence of limited knowledge about overdose prevention. Conclusions These findings suggest that preventive programs would benefit from accounting for linguistic and educational limitations and from participation in every treatment episode. Comprehensiveness and broad coverage of such programs could help to maximize their impact (AU)

Objetivos: La sobredosis por opioides sigue siendo la primera causa de muerte prevenible entre hombres jóvenes en Barcelona. El conocimiento profundo acerca de la prevención de sobredosis es importante a fin de evitar complicaciones y muertes. Los objetivos de este estudio fueron la identificación de aquellos factores asociados a un conocimiento limitado acerca de la prevención de sobredosis, y la evaluación del posible efecto sobre dicha variable del tratamiento y de la asistencia a talleres de prevención de sobredosis. Métodos Estudio transversal, mediante encuesta a usuarios de opioides por vía parenteral que acudieron a centros de reducción de daños de Cataluña entre octubre de 2008 y marzo de 2009. Se obtuvieron ratios de prevalencia crudas y ajustadas de Conocimiento limitado sobre prevención de sobredosis mediante la realización de modelos de regresión de Poisson con varianza robusta. Resultados El 28,7% de los usuarios entrevistados presentaba Conocimiento limitado sobre prevención de sobredosis. Los factores asociados a dicho Conocimiento limitado fueron el país de origen, no haber recibido tratamiento por el consumo de drogas, tener un menor nivel educativo, y nunca haber sufrido una sobredosis. El hecho de estar en tratamiento en el momento de la entrevista no se asoció a una menor prevalencia de conocimiento limitado sobre prevención de sobredosis. Conclusiones Estos hallazgos sugieren que los programas de prevención de sobredosis se verían beneficiados por tener en cuenta posibles limitaciones lingüísticas y educacionales, así como por estar integrados en todos los episodios de tratamiento. La exhaustividad y una cobertura elevada pueden ayudar a maximizar el impacto de dichos programas (AU)

Overdose prevention in injecting opioid users: the role of substance abuse treatment and training programs.

OBJECTIVES: Opioid overdose is still the first cause of preventable death among young men in Barcelona. Sound knowledge of opioid overdose prevention is important to avoid complications and deaths. This study aimed to identify the factors associated with limited knowledge of overdose prevention and to assess the possible effect of treatment and overdose prevention training programs on this variable. METHODS: From October 2008 to March 2009, current injecting opioid users attending harm reduction centers in Catalonia (Spain) were interviewed. Crude and adjusted prevalence ratios of limited knowledge about overdose prevention were calculated by adjusting Poisson regression models with a robust variance. RESULTS: In this sample, 28.7% of clients had limited knowledge of overdose prevention. Factors associated with limited knowledge were country of origin, never having received treatment for drug dependency, having a low educational level, and never having experienced an overdose. In contrast, treatment at the time of the interview was not associated with a lower prevalence of limited knowledge about overdose prevention. CONCLUSIONS: These findings suggest that preventive programs would benefit from accounting for linguistic and educational limitations and from participation in every treatment episode. Comprehensiveness and broad coverage of such programs could help to maximize their impact.

Apertura de espacios de consumo higiénico y actuaciones policiales en zonas con fuerte tráfico de drogas. Evaluación mediante el recuento de las jeringas abandonadas en el espacio público / Safe injection rooms and police crackdowns in areas with heavy drug dealing. Evaluation by counting discarded syringes collected from the public space

Se analiza la evolución de la inyección de drogas en espacios públicos usando como indicador el recuento del número de jeringuillas retiradas de la vía pública, evaluando además la influencia de las intervenciones sanitarias de reducción de daños y las policiales, mediante un estudio cuasi-experimental antes-después. Para cada intervención se contabilizan las jeringas recogidas mensualmente el semestre anterior y posterior tanto en el distrito implicado como en el conjunto de la ciudad, comparando mediante pruebas U y z la situación con un nivel de confianza del 95%. La media mensual de jeringas recogidas disminuye de 13.132 en 2004 a 3.190 en 2012. Comparando los indicadores antes y después de la apertura de espacios de consumo higiénico y de acciones policiales se aprecia que la puesta en marcha de un espacio sanitario para el consumo supervisado de drogas en el casco antiguo se acompaña de una notable reducción de las jeringas abandonadas en la ciudad, y su volumen no varía en el distrito en que está ubicado. La posterior apertura de otro espacio de consumo no comporta cambios significativos en la media de jeringas abandonadas en la zona. Algunas acciones policiales en 2005-06 y 2011 tienen un impacto notable en los indicadores de los distritos en que se producen y del conjunto de la ciudad, mientras que otras no parecen tener el mismo efecto. Los programas de reducción de daños pueden tener un impacto favorable en el consumo de drogas inyectadas en el espacio público y el abandono de jeringas. Algunas intervenciones policiales parecen tener impacto, otras no, y otras un modesto efecto local y temporal (AU)

The evolution of drug injection in public places is analysed using as indicator the number of syringes collected from public spaces, evaluating as well the influence of public health harm reduction interventions and of police actions, with a before and after quasi experimental study. Monthly syringe counts on the semester before and after each intervention were compared both in the involved district and in the city as a whole, using the U and z tests with a 95% confidence level. The average number of collected syringes drops from 13.132 in 2004 to 3.190 in 2012. Comparing indicators before and after health and police interventions, the opening of a facility with a supervised drug consumption room in the inner city was associated with a huge reduction in the number of abandoned syringes in the city, while its number did not rise in the district where the facility was located. The subsequent opening of another drug consumption room did not have a significant impact in collected syringes in the area. Some police interventions in 2005-2006 and 2011 had a significant impact in the indicators of the involved districts, while others did not. Harm reduction programs might have a favourable impact on drug injection in public spaces and related syringe presence. Some police interventions appear to have an impact while others do not or just have a modest local and temporary effect (AU)

[Safe injection rooms and police crackdowns in areas with heavy drug dealing. Evaluation by counting discarded syringes collected from the public space]. / Apertura de espacios de consumo higiénico y actuaciones policiales en zonas con fuerte tráfico de drogas. Evaluación mediante el recuento de las jeringas abandonadas en el espacio público.

The evolution of drug injection in public places is analysed using as indicator the number of syringes collected from public spaces, evaluating as well the influence of public health harm reduction interventions and of police actions, with a before and after quasi experimental study. Monthly syringe counts on the semester before and after each intervention were compared both in the involved district and in the city as a whole, using the U and z tests with a 95% confidence level. The average number of collected syringes drops from 13.132 in 2004 to 3.190 in 2012. Comparing indicators before and after health and police interventions, the opening of a facility with a supervised drug consumption room in the inner city was associated with a huge reduction in the number of abandoned syringes in the city, while its number did not rise in the district where the facility was located. The subsequent opening of another drug consumption room did not have a significant impact in collected syringes in the area. Some police interventions in 2005-2006 and 2011 had a significant impact in the indicators of the involved districts, while others did not. Harm reduction programs might have a favourable impact on drug injection in public spaces and related syringe presence. Some police interventions appear to have an impact while others do not or just have a modest local and temporary effect.