[Evolution of the prevalence of HIV infection and risk behavior of drug injection among intravenous drug users infected or not infected by HIV in 3 Spanish cities. Working Group of Physicians of the World for the monitoring of HIV infection and risk behaviors in intravenous drug users]. / Evolución de la prevalencia de infección por VIH y de prácticas de riesgo de inyección entre inyectores de drogas infectados o no por el VIH de tres ciudades españolas. Grupo de Trabajo de Médicos del Mundo para la monitorización de la infección por VIH y las prácticas de riesgo en usuarios de drogas inyectables.

OBJECTIVE: To know the evolution of HIV prevalence and risk behavior practices of drug injection in three spanish cities on the basis of the serologic status of injecting drug users. METHODS: Cross-sectional surveys among users in syringe interchange programmes. RESULTS: HIV prevalence (self-reported) decreased in Madrid from 50% (1992) down to 41% (1996) (p = 0.01) and did not change in Seville and Valencia from 1994 to 1996. Among HIV-positive injecting drug users, a decrease was observed in the practice of giving and taking used syringes in the three cities, although this decrease reached a statistically significance (p = 0.006) only for giving in Valencia from 1994 to 1996 and was almost significant (p = 0.08) for taking in Madrid from 1993 to 1996. Among HIV-negative injecting drug users, no decreases were observed in the practice of giving and taking used syringes and even a significant increase in giving syringes in Seville was recorded (p = 0.01) from 1994 to 1996. CONCLUSIONS: HIV prevalence among injecting drug users is stabilized or decreasing in the three studied cities. The prevalence of injecting risk behavior evolves differently according to the serologic status.

[Drug injection method risky for transmission of blood-borne diseases: are we careful enough?]. / Estamos estudiando adecuadamente las prácticas de inyección de drogas que implican riesgo de transmisión de enfermedades por vía parenteral?

In the last 20 years, research on the determinants of the HIV epidemic among drug users has focused mainly on studies of risk behaviour for drug injection. Studies involving human behaviour present special methodological problems. This paper presents a review of 1) the most important features that make this field different from the study of blood-borne diseases in other populations, and 2) the basic variables used in epidemiology to analyse injecting risk behaviour. Alternatives to improve research planning and results are proposed based on collaborating with other disciplines and improving the methodological resources of epidemiology.

[Emergency room admissions in cocaine users in Spanish hospitals: first evidences of acute complications related to crack use. Work Group for the Study of Emergencies from Psychostimulants]. / Urgencias en consumidores de cocaína en varios hospitales españoles: primeras evidencias de complicaciones agudas por consumo de crack. Grupo de Trabajo para el Estudio de Urgencias por Psicoestimulantes.

BACKGROUND: Acute complications of cocaine are increasing in Spain, nevertheless little information is available on its clinical and toxicological characteristics. MATERIAL AND METHOD: Records from medical emergency rooms of 14 hospitals from Madrid, Valencia and Gran Canaria were reviewed. Records were selected if the term "cocaine" was mentioned, excluding those related with injuries or obstetric, gynecologic and pediatric problems. Emergency room episodes were classified in three groups according its relation with cocaine use. RESULTS: 223 episodes were directly related to cocaine, some of these simultaneously related to heroin (36%) or alcohol. The proportion of all emergency room episodes related to cocaine was threefold higher in Gran Canaria than in Madrid and Valencia. In Gran Canaria most of episodes (72%) were related to cocaine smoking, generally crack, but in Madrid and Valencia most were due to intravenous cocaine use. The most common signs and symptoms were anxiety, mydriasis, syncope, tachycardia, shortness of breath, confusion or coma, agitation, chest pain and palpitations. Mental disorders were the most common diagnoses. 13% of patients were admitted as inpatients to hospital or were referred to another hospital (23.6, 17.3 and 2.2%, if cocaine was smoked, injected and sniffed, respectively). Cardiovascular diagnosis were less frequent in episodes simultaneously related to opioids than in not opioids-related episodes (1.1% vs 10.7%; p = 0.005). Furthermore, 219 not cocaine-related episodes were identified. The relation to cocaine could not be established in other 275 episodes. CONCLUSIONS: This work show for the first time in Spain the presence of crack-related emergency episodes and suggests that injecting and smoking cocaine has a greater impact on public health than sniffing this drug.

[Epidemiology of designer drug use in Spain]. / Epidemiología del consumo de drogas de diseño en España.

BACKGROUND: To provide epidemiological information on the extent of design drug use in Spain, the characteristics of users, and the types of substances consumed. MATERIALS AND METHODS: We analyzed two surveys on drug use carried out in 1993 and 1994 (one in the general population older than 15 years and the other in heroin and/or cocaine users who were not in treatment) as well as data on designer drug seizures confiscated by the General Police Headquarters and Ministry of Health laboratories. RESULTS: According to the general population survey, 4.5% of persons 16-40 years of age have tried design drugs at some time, 2.1% more than once, and 0.6% are current users. Design drug use is associated with age of 20-24 years and use of crack (odds ratio [OR] = 28.6), cannabis (OR = 12.5), cocaine (OR = 7.6) or heroin (OR = 3.8). According to the survey of heroin/cocaine users, 25% of cocaine users have used design drugs in the last 30 days, 11% of heroin users, and 18% of those who use both substances. Use is associated with the use of hallucinogens (OR = 4.8), non-use of the injected route (OR = 2), and having been interviewed in recreational areas (OR = 1.8). Police data reflect a stability in the quantities of amphetamines confiscated, a large increase in those of MDMA, and an absence of MDA and MDEA. Ministry of Health laboratories show an increase in confiscations of amphetamines and the presence of MDA, MDMA and MDEA in all years and areas studied, as well as the appearance of MBDB in 1994. CONCLUSIONS: The occasional use of different design drugs has spread to some degree among young people, varies considerably by geographic region, and is associated with the use of other legal and illegal substances, specially stimulants.

[Patterns of cocaine use among cocaine users who do not use heroin recruited outside of treatment centers]. / Patrones de uso de cocaína en un grupo de consumidores de esta droga sin consumo de heroína captados fuera de los servicios asistenciales.

BACKGROUND: In Spain cocaine use, although relatively widespread, has produced few health problems, most likely because there is a preponderance of non-intensive intranasal use. To obtain data in this regard, we investigated the history and patterns of use in a group of cocaine users. SUBJECTS AND METHODS: Cross-sectional survey carried out in 1993 among 381 cocaine users (289 men and 92 women) who did not use heroin and had not received treatment for drug dependence, recruited by non-probabilistic sampling outside of treatment centers in 35 Spanish cities. The results are presented separately for men and women. RESULTS: The persons interviewed predominantly took cocaine sporadically, during the weekend, in moderate amounts (less than 0.4 g/day) and by the intranasal route. For only 7.2% was it very difficult or impossible to give up cocaine. These characteristics had persisted throughout the users' history; few users (18.1%) had taken cocaine more than 3 times a week in any period or had used a main route other than the intranasal route (10.8%). The proportion of those interviewed who used other drugs, mainly alcohol, tobacco and cannabis, was larger than in the general population in the same age group; interviewees also had a higher educational level and a lower level of unemployment. Women used cocaine, alcohol and tobacco in smaller amounts than men, and a smaller proportion of women stated that it was very difficult or impossible to give up cocaine. CONCLUSIONS: In Spain, the cocaine users who do not use heroin have better educational and employment levels than general population, and generally they use cocaine sporadically, in moderate amounts and by the intranasal route. These circumstances may contribute to explain the relative scarcity of health problems associated to cocaine use.

[Emergencies associated with the consumption of designer drugs, hallucinogens and amphetamines treated at 15 Spanish hospitals in 1994. Work Group on the Study of Emergencies due to Psychostimulants]. / Urgencias relacionadas con el consumo de drogas de diseño, alucinógenos y anfetaminas atendidas en quince hospitales españoles durante 1994. Grupo de Trabajo para el Estudio de las Urgencias por Psicoestimulantes.

The clinical records of patients attended at emergency hospitals in fifteen hospitals in Madrid, Valencia and Gran Canaria during 1994 were retrospectively analyzed. Seventy-three emergencies related to the consumption of design drugs, hallucinogens or amphetamines (100 times lower than because of opiates or cocaine) were recorded. Apart from the responsible drug for the emergency visit, in most cases the usual consumption of other substances was mentioned. Acute psychopathological reactions predominated. Three patients were admitted and five were derived to other hospitals; the remaining patients improved and were discharged. The number of emergencies on account of these drugs is relatively low, with a proportion of less than one in 10,000 emergencies attended in these areas and might not radically change if the current predominant consumption pattern is maintained.

[Risk behaviors for HIV transmission among the recent clients of a syringe-exchange program in Madrid, 1993]. / Conductas de riesgo para transmisión del VIH entre los usuarios recientes de un programa de intercambio de jeringas en Madrid, 1993.

OBJECTIVE: To determine the prevalence of the major risk behavior in HIV transmission (syringe sharing and failure to use condoms) and associated factors among drug injectors recruited for a syringe exchange program (PIJ) in the city of Madrid. METHODS: Cross-section study. All the information was obtained in 1993 through structured interviews with 441 users who had injected drugs during the previous month and had resorted to the PIJ five times, at most. The reference period for drug use and risk behaviour was the month prior to the interview. The statistical analysis included bivariate methods and logistical regression techniques. RESULTS: 29.2% shared syringes (18% passing and 21.7% taking used syringes) and of those that had sexual intercourse (49.4%), 42.5% always used a condom. 89.5% had an HIV antibody test and of those that knew the results, 48.6% were HIV-positive. Multivariate analysis showed that the association between certain behaviour patterns was significant; i.e., taking used syringes and: passing used syringes (odds ratio -OR- = 6.1; 95% confidence interval -CI- = 3.0-12.5), being HIV-positive (OR = 4.1; CI = 1.8-9.1), being unaware of HIV antibody test status (OR = 4.2; CI = 1.7-10.2) and having used intravenous drugs for 5-9 years (OR = 2.9; CI = 1.1-7.9); the association was significant between passing used syringes and: using a mixture of heroin and cocaine (OR = 2.7; CI = 1.1-6.4) and being unaware of HIV antibody test status (OR = 2.5; CI = 1.1-6.0). In the sample as a whole, the association between not using condoms ever and consuming cocaine (OR = 1.7; CI = 1.1-2.9) or crack (OR = 3.0; CI = 1.5-5.9) was significant; furthermore, among those that had sexual intercourse, the association was significant between not using condoms ever and: having been in jail (OR = 2.9; CI = 1.3-6.4), injecting drugs 2-4 times a day (OR = 2.4; CI = 1.0-5.8), having sexual intercourse with drug injectors (OR = 2.6; CI = 1.2-5.9) and having intercourse with two or more partners (OR = 0.4; CI = 0.2-0.9). CONCLUSIONS: The prevalence of HIV infection and risk behavior in the transmission of this virus remain high among drug injectors in Madrid. The habit of sharing syringes is still common, especially among HIV-positive drug injectors (a high percentage take used syringe) and among those who are unaware of their HIV antibody test status. The use of condoms is less frequent among those who have sexual intercourse with other drug injectors or with only one partner.

The epidemiology of cocaine use in Spain.

Trends and patterns of cocaine use in Spain are described with the aid of different information sources such as population surveys, the State Information System on Drug Abuse, and anthropological studies. In recent years the magnitude of cocaine supply indicators has increased greatly. High levels of last-month prevalence of cocaine use have been detected among the general population--consistently higher than those for heroin-- and cocaine consumption among heroin users has increased. Although the frequency of some health problems related to cocaine use--treatment admissions, hospital emergency admissions--has increased, it is still 30 times less than for heroin. Various hypotheses to explain these discrepancies are discussed.

[Quality of the certification of death due to acute reaction to opiates and cocaine among inhabitants of the City of Madrid]. / Calidad de la certificación de la muerte por reacción aguda a opiáceos y cocaína entre residentes del municipio de Madrid.

BACKGROUND: Deaths by acute reaction from drugs consumption (RAD) particularly heroine or cocaine, collected in routine morality statistics, have not changed substantially during the last ten years, whereas an specific collection system (State Information System on Drug-Abuse SISD) presented a great increase. For this reason, we try to measure the validity of drug-related deaths certificate. METHODS: The cause of death, corresponding to the persons, from 15 to 39 years of age, decreased in 1988 and residing in the Municipality of Madrid, registered in the Civil Register Decease Book and in the death Statistics Bulletins (DSB) was compared with the cause present in the autopsy report. RESULTS: A detection rate of 2.45% for the CR and 3.27% for the DSB were obtained. With the consequent correction, the RAD for this age group would be the second cause of mortality in the Municipality of Madrid and deaths related to circulatory and respiratory system would decrease in a great measure. CONCLUSIONS: It is necessary to improve substantially the collection of this cause of death in mortality statistics if we want a correct measurement of drug abuse lethal effects and the effectiveness of control programmes on this health problem.