Estimating Prevalence of Illicit Drug Use in Yunnan, China, 2011-15.

Background and Aims: Yunnan has been one of the provinces most afflicted by illicit drug use in China. However, there have been few systematic studies on the prevalence of illicit drug use in the area. Method: Using data on illicit drug users registered in the police system, this study aims to estimate the population size of illicit drug users and the annual prevalence of drug use in Yunnan from 2011 to 2015 using Zelterman's capture-recapture method. Results: In the 15-64 year-old population, the estimated prevalence rate of any illicit drug use was 0.81% (0.76-0.86%) in 2011 and 0.94% (0.90-0.98%) in 2014, representing a significant increase. The prevalence rate of heroin use decreased from 0.67% (0.63-0.73%) in 2011 to 0.57% (0.53-0.61%) in 2015, while the prevalence rate of methamphetamine use doubled from 0.20% (0.17-0.24%) in 2011 to 0.48% (0.46-0.50%) in 2015. The mean age of the 141,702 identified illicit drug users in Yunnan from 2011 to 2015 was 32.2 years, and the majority were male, low educated, and peasants; nearly half were single and ethnic minorities. The ratio of the number of identified illicit drug users to the number of hidden users increased from 1:12 in 2011 to 1:5 in 2015. Conclusion: The prevalence of illicit drug use in Yunnan has been increasing. Although the prevalence of heroin use decreased, methamphetamine use increased dramatically from 2011 to 2015. Preventive strategies that are more effective in reducing illicit drug use are urgently needed in Yunnan.

Predictors of Poor Adherence to Methadone Maintenance Treatment in Yunnan Province, China.

BACKGROUND: China initiated the methadone maintenance treatment (MMT) program since 2004. The main challenge has been poor clinic adherence, which has a serious impact on treatment efficacy. OBJECTIVES: The aim of the study was to identify predictors of poor adherence to MMT in Yunnan Province, China. METHODS: We performed a case-control study of 764 patients, newly enrolled or re-enrolled on MMT programs, between January 1, 2007 and December 31, 2011. Information was obtained from clinic databases. RESULTS: The frequency of poor adherence was 561 (73.43%). Lower daily methadone dosage (<60 mg) was significantly associated with poor adherence (odds ratio 4.07; 95% confidence interval, 2.88-5.74; P value < 0.001). Younger age was also a significant predictor of poor adherence (odds ratio 1.04; 95% confidence interval, 1.01-1.05; P value < 0.01). CONCLUSIONS: Higher dosage of methadone is recommended as a way to improve treatment adherence.

Sleeping problems in Chinese illicit drug dependent subjects.

BACKGROUND: Illicit drug use/dependence has been recognized as a major problem. Clinical studies demonstrate that poor sleep quality is associated with increased frequency of drug use and relapse. However, few studies have addressed the issue of sleep quality among illicit drug dependent subjects. METHODS: This cross-sectional study explored sleep quality in drug dependent subjects in China. We studied 2178 illicit drug dependent subjects from drug rehabilitation centres in Changsha and 2236 non-drug-using subjects, all of whom completed the self-report Pittsburgh Sleep Quality Index (PSQI). RESULTS: We found that the prevalence of sleep disturbance was much higher in drug users (68.5%, PSQI >5; specifically, 80.24% in heroin users, 54.16% in methamphetamine users and 81.98% in ketamine users with PSQI >5) than non-users (26.4%, PSQI >5). Drug users had approximately twice the sleep latency than nondrug users (37.7 minutes V.S 18.4 minutes). Although drug users and non-users reported similar sleep duration (about 7.4 hours), drug users showed poorer subjective sleep quality and habitual sleep efficiency. They reported more sleep disturbance and need for sleep medications, more daytime dysfunction and poorer subjective sleep quality compared with nondrug users. The total PSQI score positively correlated with the duration of drug use (rp = 0.164, p < 0.001). We also found a link between sleep problems and cigarette smoking, alcohol drinking, and duration of drug use. CONCLUSIONS: Poor sleep quality is common among illicit drug dependent subjects. Long-term substance users had more sleep problems. Future research aiming at quantifying the benefits of treatment interventions should not neglect the influence of sleep problems. Gaining more insight into the impact of sleep quality on the addiction treatment could also help to target future intervention measures more effectively.

Perceived risk of methamphetamine among Chinese methamphetamine users.

BACKGROUND: Methamphetamine use has grown considerably in China in recent years. Information about perceptions of risk on methamphetamine is important to facilitate health promotion efforts. METHODS: Using both survey data and qualitative interview data, the authors evaluate the perceived risk of methamphetamine use among Chinese users using a mixed-methods approach. Through Respondent Driven Sampling, the authors recruited a sample of 303 methamphetamine users in Changsha, China. RESULTS: A majority (59.1%) perceive that infrequent methamphetamine use poses no risk to the user, while 11.2% perceive at least moderate risk for light use. A majority (56.7%) perceived at least moderate risk associated with regular methamphetamine use. Most (82.2%) also perceive methamphetamine to be easily obtainable. A path model indicates that perceived risk shapes intentions to use and expectations of future use, as does perceived availability. Qualitatively, while addiction was the most common risk discussed by users, they differed on whether they perceived the drug addictive. Other concerns raised by interviewees included impaired cognition, mental health problems, physical harm, and social dysfunction. CONCLUSION: While some users identify significant risks with methamphetamine, others do not perceive its use to be problematic. Collectively, these findings indicate that intervening upon perceptions of risk among Chinese methamphetamine users may be a means to influence intentions to use.

Factors related to psychosocial barriers to drug treatment among Chinese drug users.

Although substance abuse treatment has been considerably scaled up in China, impediments to accessing these services remain among drug users. The authors examine the primary psychosocial barriers to drug treatment in this population and evaluate factors associated with these barriers. Barriers to accessing drug treatment were measured using the Barriers to Treatment Inventory (BTI). A Structural Equation Model was used to examine whether the internal barriers were associated with treatment history and frequent methamphetamine use as well as how demographic characteristics influence such barriers. We found four primary factors of internal barriers to drug treatment--absence of problem, negative social support, fear of treatment, and privacy concerns--to fit well. Demographic factors, notably age and employment status, indirectly influence barriers to treatment via other factors. Frequency of methamphetamine use and drug treatment history are directly associated with the absence of problem and negative social support dimensions of the BTI, and it is through these pathways that demographic factors such as age and employment status shape barriers to treatment. The findings indicate that perceived absence of a problem and negative social support are the barriers most influenced by the personal domains of Chinese drug users' lives. Efforts to engage drug users in China about drug treatment options may consider how these barriers are differentially perceived in order to effectively reach this population.

Factorial structure of the Brief Symptom Inventory (BSI)-18 among Chinese drug users.

BACKGROUND: Although the Brief Symptom Inventory-18 (BSI-18) has been widely used for mental health screenings in both clinical and non-clinical populations, the validation of its application to Chinese populations has been very limited. The objective of this research is to assess the factorial structure of the BSI-18 within a Chinese drug using population. METHODS AND RESULTS: A total sample of 303 drug users recruited via Respondent Driven Sampling (RDS) from Changsha, China was used for the study. Our results show: (1) The BSI-18 item scores are highly skewed; (2) With dichotomous items measures (1 - problem at least moderately caused respondent discomfort during the past week; 0 - otherwise), our findings support the designed 3 - factor solution of the BSI-18 (somatization, depression, and anxiety); (3) The BSI-18 has a hierarchical factorial structure with 3 first-order factors and an underlying second-order factor (general psychological distress); (4) Tentative support should also be given to a single dimension of general psychological distress in Chinese drug using populations. Our study recommends a useful alternative approach for evaluating the factorial structure of the BSI-18 - i.e. CFA with dichotomous item measures. Both the total BSI-18 score and the three subscales (SOM, DEP, and ANX) can be used in applications of the BSI-18. CONCLUSION: Overall, our findings suggest the BSI-18 is useful with Chinese drug users, and shows potential for use with non-Western and substance using populations more generally.

Perceptions of HIV risk among methamphetamine users in China.

BACKGROUND: Methamphetamine use has emerged in China over the past decade. With the growth in methamphetamine use, it remains uncertain how users in China perceive its association with the HIV epidemic. METHODS: The authors utilize qualitative and survey data from a mixed-methods study on methamphetamine use and HIV risk in China to assess the extent to which users perceive a risk for HIV transmission as well as how they conceive of the drug's links to HIV. RESULTS: Data indicate that a considerable majority (82.2%) perceived themselves to have zero risk for HIV infection. Qualitative interviews highlight the lack of information about HIV possessed by methamphetamine users given the confusion and disbelief often expressed. Others acknowledged that while there was an intertwining of risk, they were not personally at risk. CONCLUSION: Given the known association between methamphetamine use and HIV risk, health promotion initiatives in China should target methamphetamine users to build HIV-related knowledge and inhibit self-exempting beliefs. In particular, educational efforts regarding the association of methamphetamine use with HIV may inhibit risk behaviors.

Perceived interpersonal pressure and drinking behavior in South China.

BACKGROUND: Interpersonal pressure of drinking during social activities might be a unique cultural phenomenon in China. This study is designed to evaluate the reliability and validity of a measurement on perceived interpersonal pressure and to examine the relationship between perceived interpersonal pressure and drinking behavior. METHODS: A total of 1027 community residents participated in this cross-sectional study, with a response rate of 71.3%. All data were collected through face-to-face interviews. Perceived interpersonal pressure was assessed with a six-item self-reported scale; the three drinking measures included overall heavy drinking, large quantity drinking in a single occasion, and repeat acute intoxication. RESULTS: The Cronbach's α coefficient of the six item scale was 0.81 and the intra-class correlation for test-retest was 0.796. Those who were male, younger, employed, married, and had higher income reported higher pressure from superiors, while those who were male, younger, and had higher income also reported higher pressure from peers. The Spearman correlation coefficients between drinking buddies and pressure from superiors, from peers, and total pressure score were 0.394, 0.523, and 0.555, respectively (all p values<0.001). After controlling for sociodemographic characteristics, perceived interpersonal pressure was an independent risk factor of large quantity drinking (OR=4.69, 95%CI=2.67-8.25) and repeated intoxication (OR=3.44, 95%CI=1.84-6.44), but was not correlated to overall heavy drinking (OR=1.54, 95%CI=0.67-3.53). CONCLUSIONS: The measurement of perceived interpersonal pressure shows satisfactory reliability and validity. Perceived interpersonal pressure is related to large quantity drinking and intoxication but not related to overall heavy drinking.

Histone acetylation of the htr3a gene in the prefrontal cortex of Wistar rats regulates ethanol-seeking behavior.

Previous reports showed that decreased histone deacetylase activity significantly potentiated the rewarding effects of psychostimulants, and that encoding of the 5-HT3 receptor by the htr3a gene was related to ethanol-seeking behavior. However, the effects of a histone deacetylase inhibitor on ethanol-seeking behavior and epigenetic regulation of htr3a mRNA expression after chronic ethanol exposure are not fully understood. Using quantitative reverse transcription-polymerase chain reaction and chromatin immunoprecipitation analysis, we investigated the effects of chronic ethanol exposure and its interaction with a histone deacetylase inhibitor on histone-acetylation-mediated changes in htr3a mRNA expression in the htr3a promoter region. The conditioned place preference procedure was used to evaluate ethanol-seeking behavior. Chronic exposure to ethanol effectively elicited place conditioning. In the prefrontal cortex, the acetylation of H3K9 and htr3a mRNA expression in the htr3a promoter region were significantly higher in the ethanol group than in the saline group. The histone deacetylase inhibitor sodium butyrate potentiated the effects of ethanol on htr3a mRNA expression and enhanced ethanol-induced conditioned place preferences. These results suggest that ethanol upregulates htr3a levels through mechanisms involving H3K9 acetylation, and that histone acetylation may be a therapeutic target for treating ethanol abuse.