Advertisement

Canadian Journal of Public Health

, Volume 99, Issue 3, pp 178–181 | Cite as

Increasing Prevalence of Cocaine as the Primary Detoxification Diagnosis among Admissions Presenting with Current Intravenous Drug Use

A Review of Detoxification Records from Northern British Columbia, 1999–2005
  • Russell C. Callaghan
  • Carol Strike
  • Thomas Kerr
  • Benedikt Fischer
  • Jane Buxton
  • Emma Stevens
  • Lawren Taylor
  • J. Charles Victor
Article

Abstract

Objectives

This study sought to document the trends in drug use among intravenous drug users (IDUs) in northern British Columbia, and to discuss the public health implications.

Objectives

This study sought to document the trends in drug use among intravenous drug users (IDUs) in northern British Columbia, and to discuss the public health implications.

Method

We conducted a 7-year medical-chart review of all IDU-related admissions (n=2072) to an inpatient alcohol and drug detoxification centre in Prince George, British Columbia. Primary detoxification diagnosis was modeled onto year of admission using generalized estimating equations (GEE).

Results

Our study demonstrated an increasing prevalence of cocaine as the primary detoxification diagnosis in IDU-related admissions in northern BC, from 32% of all IDU admissions in 1999 to 64% in 2001, and then a relatively steady elevated rate of approximately 60% between 2001–2005.

Conclusions

Given that needle exchange programs and other harm reduction services for IDUs in British Columbia are not readily available in many northern and rural areas, the risks associated with intravenous cocaine use among northern IDUs represent a serious public health challenge. Tailored harm reduction strategies should take into account the prominence of intravenous cocaine use as an HIV risk factor. In areas without well-established intravenous drug use monitoring programs, such as rural and remote areas, detoxification treatment records may serve as important sentinels for changing drug use patterns among IDUs.

Key words

Substance abuse, intravenous cocaine rural health services treatment centers, substance abuse 

Résumé

Objectifs

Notre étude visait à documenter les tendances de la consommation de drogue chez les utilisateurs de drogue injectable (UDI) dans le Nord de la Colombie-Britannique et à examiner leurs conséquences pour la santé publique.

Méthode

Nous avons examiné les fiches médicales sur 7 ans de toutes les hospitalisations d’UDI (n=2 072) dans un centre de désintoxication de Prince George (Colombie-Britannique). Le principal diagnostic de désintoxication a été modélisé sur l’année d’hospitalisation à l’aide d’équations d’estimation généralisées (EEG).

Résultats

L’étude a montré une prévalence croissante de l’abus de cocaïne comme principal diagnostic de désintoxication dans les hospitalisations liées à l’utilisation de drogues injectables du Nord de la Colombie-Britannique; ce diagnostic est passé de 32% des hospitalisations d’UDI en 1999 à 64% en 2001, puis il s’est stabilisé à un niveau relativement élevé (environ 60%) entre 2001 et 2005.

Conclusion

Étant donné que les programmes d’échange de seringues et autres services de réduction des méfaits destinés aux UDI en Colombie-Britannique ne sont pas aisément accessibles dans de nombreuses régions nordiques et rurales, les risques associés à l’injection de cocaïne chez les UDI du Nord présentent un défi de taille pour la santé publique. Les stratégies de réduction des méfaits adaptées doivent tenir compte de la prédominance de la consommation de cocaïne par voie intraveineuse comme facteur de risque du VIH. Dans les secteurs qui n’ont pas de programmes établis pour la surveillance de l’utilisation de drogues injectables, les régions rurales et éloignées par exemple, les dossiers des centres de désintoxication peuvent être d’importantes sentinelles des changements dans les habitudes de consommation de drogue des UDI.

Mots clés

abus de drogues intraveineuses cocaïne services de santé ruraux centres de désintoxication 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Spittal PM, Craib KJ, Teegee M, Baylis C, Christian WM, Moniruzzaman AK, Schechter MT; Cedar Project Partnership. The Cedar Project: Prevalence and correlates of HIV infection among young Aboriginal people who use drugs in two Canadian cities. Int J Circumpolar Health 2007;66(3):226–40.CrossRefGoogle Scholar
  2. 2.
    Millson P, Myers T, Calzavara L, Wallace E, Major C, Degani N. Regional variation in HIV prevalence and risk behaviours in Ontario injection drug users (IDU). Can J Public Health 2003;94(6):431–35.PubMedGoogle Scholar
  3. 3.
    Health Canada. I-Track: Enhanced surveillance of risk behaviors among injecting drug users in Canada: Pilot Survey Report. Ottawa, ON: Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Health Canada, 2004.Google Scholar
  4. 4.
    Public Health Agency of Canada. I-Track: Enhanced Surveillance of Risk Behaviors among People who Inject Drugs. Phase I report, August 2006. Ottawa: Surveillance and Risk Assessment Division, Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada, 2006.Google Scholar
  5. 5.
    Des Jarlais DC, Dehne K, Casabona J. HIV surveillance among injecting drug users. AIDS 2001;15(Suppl 3):S13–S22.CrossRefGoogle Scholar
  6. 6.
    Goldberg D. Methodology of the World Health Organization Multi-City Study on Drug Injecting and Risk of HIV Infection. In: Stimson GV, Des Jarlais DC, Ball AL (Eds.), Drug Injecting and HIV Infection: Global Dimensions and Local Responses. London, UK: UCL Press, 1998; 233–42.Google Scholar
  7. 7.
    Des Jarlais DC, Perlis TE, Stimson GV, Poznyak V. Using standardized methods for research on HIV and injecting drug use in developing/transitional countries: Case study from the WHO Drug Injection Study Phase II. BMC Public Health 2006;6:54.CrossRefGoogle Scholar
  8. 8.
    Hay G. Capture-recapture estimates of drug misuse in urban and non-urban settings in the north east of Scotland. Addiction 2000;95(12):1795–803.CrossRefGoogle Scholar
  9. 9.
    Magnani R, Sabin K, Saidel T, Heckathorn DD. Review of sampling hard-to-reach and hidden populations for HIV surveillance. AIDS 2005;19(Suppl 2):S67–S72.CrossRefGoogle Scholar
  10. 10.
    Tukey J. Exploratory Data Analysis. Reading, MA: Addison-Wesley, 1977.Google Scholar
  11. 11.
    Twisk JW, Smidt N, de Vente W. Applied analysis of recurrent events: A practical overview. J Epidemiol Community Health 2005;59:706–10.CrossRefGoogle Scholar
  12. 12.
    Ministry of Health Services. HIV/AIDS and problematic substance use prevention: Needle Exchanges. July 21, 2005. Available online at: https://doi.org/www.healthservices.gov.bc.ca/hiv/needle.html (Accessed September 27, 2005).Google Scholar
  13. 13.
    Wood E, Stoltz J-A, Li K, Montaner JSG, Kerr T. Changes in Canadian heroin supply coinciding with the Australian heroin shortage. Addiction 2006;101:689–95.CrossRefGoogle Scholar
  14. 14.
    Royal Canadian Mounted Police. Drug Situation in Canada — 2004. September 22, 2005. Available online at: https://doi.org/www.rcmp-grc.gc.ca/crimint/drugs_2004_e.htm (Accessed December 7, 2006).Google Scholar
  15. 15.
    Darke S, Baker A, Dixon J, Wodak A, Heather N. Drug use and HIV risk-taking behaviour among clients in methadone maintenance treatment. Drug Alcohol Depend 1992;29(3):263–68.CrossRefGoogle Scholar
  16. 16.
    Darke S, Kaye S, Topp L. Cocaine use in New South Wales, Australia, 1996–2000: 5 year monitoring of trends in price, purity, availability and use from the illicit drug reporting system. Drug Alcohol Depend 2002;67(1):81–88.CrossRefGoogle Scholar
  17. 17.
    Bux DA, Lamb RJ, Iguchi MY. Cocaine use and HIV risk behavior in methadone maintenance patients. Drug Alcohol Depend 1995;37(1):29–35.CrossRefGoogle Scholar
  18. 18.
    Hudgins R, McCusker J, Stoddard A. Cocaine use and risky injection and sexual behaviors. Drug Alcohol Depend 1995;37(1):7–14.CrossRefGoogle Scholar
  19. 19.
    Chaisson RE, Bacchetti P, Osmond D, Brodie B, Sande MA, Moss AR. Cocaine use and HIV infection in intravenous drug users in San Francisco. JAMA 1989;261(4):561–65.CrossRefGoogle Scholar
  20. 20.
    Giannini AJ, Miller NS, Loiselle RH, Turner CE. Cocaine-associated violence and relationship to route of administration. J Subst Abuse Treat 1993;10(1):67–69.CrossRefGoogle Scholar
  21. 21.
    Tyndall MW, Currie S, Spittal P, Li K, Wood E, O’Shaughnessy MV, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS 2003;17(6):887–93.CrossRefGoogle Scholar
  22. 22.
    Callaghan RC, Taylor L, Tavares J. HIV among Aboriginal and non-Aboriginal injection drug users admitted to inpatient detoxification in northern British Columbia: A 6-year medical-chart review. Submitted for Publication 2006.Google Scholar
  23. 23.
    Office of Applied Studies. Treatment Episode Data Set (TEDS) Highlights — 2003 National Admissions to Substance Abuse Treatment Services. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2005. Report No.: DHHS Publication No. (SMA) 05-4043.Google Scholar
  24. 24.
    Darke S. Self-report among injecting drug users: A review. Drug Alcohol Depend 1998;51(3):253–63; discussion 267–68.CrossRefGoogle Scholar
  25. 25.
    Zanis DA, McLellan AT, Randall M. Can you trust patient self-reports of drug use during treatment? Drug Alcohol Depend 1994;35(2):127–32.CrossRefGoogle Scholar
  26. 26.
    Callaghan RC, Taylor L, Tavares J. Addressing the needs of injection drug users in detoxification treatment. J Subst Abuse Treat 2006;30(2):165–66.CrossRefGoogle Scholar

Copyright information

© The Canadian Public Health Association 2008

Authors and Affiliations

  • Russell C. Callaghan
    • 1
  • Carol Strike
    • 1
  • Thomas Kerr
    • 2
    • 3
  • Benedikt Fischer
    • 4
  • Jane Buxton
    • 3
    • 5
  • Emma Stevens
    • 6
  • Lawren Taylor
    • 1
  • J. Charles Victor
    • 1
  1. 1.Centre for Addiction and Mental HealthTorontoCanada
  2. 2.Centre for Excellence in HIV/AIDSVancouverCanada
  3. 3.Department of MedicineUniversity of British ColumbiaVancouverCanada
  4. 4.Centre for Addiction ResearchVancouverCanada
  5. 5.British Columbia Centre for Disease ControlVancouverCanada
  6. 6.RCMP North DistrictPrince GeorgeCanada

Personalised recommendations