Increased drug use and the timing of social assistance receipt among people who use illicit drugs
Increased drug use and the timing of social assistance receipt among people who use illicit drugs
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DOI：
10.1016/j.socscimed.2016.11.006
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发表时间：
2016-12-01
影响因子：
5.4
通讯作者：
Richardson, Lindsey
中科院分区：
文献类型：
--
作者：
Krebs, Emanuel;Wang, Linwei;Richardson, Lindsey
背景资料：每月向使用非法药物的人（PWUD）支付的社会援助（SA）与毒品相关危害的增加有时间关系。然而，与本月其他时间的使用水平相比，SA接收是否会改变药物使用强度尚未确定。因此，我们研究了这种关系之间的PWUD在加拿大温哥华（2005-2013）。方法：数据来自前瞻性队列的HIV阳性和HIV阴性的PWUD。每六个月，参与者被问及他们在过去180天和过去一周内使用非法药物的情况。我们确定SA接收是否发生在评估的一周召回期内。我们采用控制混杂因素的广义估计方程来检查SA接收与药物使用强度变化之间的关系，药物使用强度定义为与前6个月相比，上周使用给定药物的平均每日次数增加100%。我们通过对个体是否主要使用兴奋剂、非法阿片类药物或参与多种药物使用进行分层分析，并检查SA接收时间相对于评估日期的时间，来测试这种关系的稳健性。我们的研究包括2661名个体（中位年龄36岁，32%为女性），其中1415例（53.2%）报告在评估的一周回忆期内至少接受过一次SA。接受SA与强化药物使用独立相关（调整后的比值比[AOR]：1.79; 95%置信区间[CI]：1.53，2.09），当按主要使用兴奋剂分层时，仍具有显著性（AOR：1.87; 95% CI：1.54，2.26）、阿片类药物（AOR：1.96; 95% CI：1.23，3.13）和多种药物使用（AOR：1.53; 95% CI：1.11，2.10）。虽然SA的健康和社会效益是显着的，这些研究结果表明，替代支付策略，如交错或更小，更频繁的SA付款可能能够减轻药物相关的伤害。应严格测试替代品。(C)2016爱思唯尔有限公司版权所有
Background: The monthly disbursement of social assistance (SA) payments to people who use illicit drugs (PWUD) has been temporally associated with increases in drug-related harm. Yet, whether SA receipt changes drug use intensity compared to levels of use at other times in the month has not been established. We therefore examined this relationship among PWUD in Vancouver, Canada (2005-2013).Methods: Data were derived from prospective cohorts of HIV-positive and HIV-negative PWUD. Every six months, participants were asked about their illicit drug use during the last 180 days and the past week. We determined whether SA receipt occurred within the assessment's one-week recall period. We employed generalized estimating equations controlling for confounders to examine the relationship between SA receipt and the change in drug use intensity, defined as a 100% increase in the average times per day a given drug was used in the last week compared to the previous 6 months. We tested the robustness of this relationship by stratifying analyses by whether individuals primarily used stimulants, illicit opioids or engaged in polydrug use and examining the timing of SA receipt relative to date of assessmentResults: Our study included 2661 individuals (median age 36, 32% female) with 1415 (53.2%) reporting SA receipt occurring within the one-week recall period of the assessment at least once. SA receipt was independently associated with intensified drug use (Adjusted Odds Ratio [AOR]: 1.79; 95% Confidence Interval [CI]: 1.53, 2.09), and remained significant when stratified by primary use of stimulants (AOR: 1.87; 95% CI: 1.54, 2.26), opioids (AOR: 1.96; 95% CI: 1.23, 3.13) and polydrug use (AOR: 1.53; 95% CI: 1.11, 2.10).Conclusion: We found a temporal association between SA receipt and drug use intensification. While the health and social benefits of SA are significant, these findings suggest that alternative disbursement strategies, such as staggered or smaller and more frequent SA payments may be able to mitigate drug related harm. Alternatives should be tested rigorously. (C) 2016 Elsevier Ltd. All rights reserved.