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Open Access Publications from the University of California

Scholarly Works (14 results)

  • Thesis
  • Peer Reviewed
UC San Francisco Electronic Theses and Dissertations (2009)

This dissertation traces an `alternative topography' of San Francisco, in which the roles of past and current judicial status, locations of key resources, economic strategies, the locations of usable public spaces, and recent and current relationships with others have become the crucial contours shaping the movements and practices of daily life for young, predominantly homeless people who inject drugs in San Francisco in the period 2003--2008.

The project utilized qualitative and quantitative interviews, ethnographic fieldnotes, historical and contemporary documents, and secondary data sources such as land use maps and census data. These data were analyzed using a grounded theory/situational analysis approach.

Substantiative findings include: how young homeless people sought to make money heavily shaped the ways they related to different parts of the city and how they moved between them, with substantial implications for public health interventions attempting to target this population; and that how people `know' and `create' places, and the processes by which those understandings are contested likewise heavily impact they ways people move through built environments, likewise with substantial implications for public health.

Full text at http://mouldypumpkin.com/dissertation/2009_Davidson.pdf

    Cover page: Space, place, and young injecting drug users in San Francisco
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2019)

    Background: More than 70,000 people died in the United States in 2017 as a result of a drug-related overdose. Among those who died, 46,600 died from the use of an opioid. While several policies have been enacted to reduce the harms caused by drug use, by increasing access to substance use disorder (SUD) treatment, little is known about how these policies have transformed the SUD treatment industry.

    Aims: (1) determine the effectiveness of the ACA at addressing SUD related issues using a policy analysis approach (2) qualitatively investigate how changes in healthcare policy have negatively impacted substance use treatment services and caused abuses in the treatment industry, and (3) quantitatively analyze factors associated with non-fatal opioid overdose among a suburban/exurban opioid-using population in Southern California.

    Methods: Professionals in the addiction field (Chapter 2 and 3; n = 20), people who misuse opioids (PWMO) who attended SUD treatment (Chapter 3; n = 20), and PWMO (Chapter 4; n = 355) were interviewed. Thematic data analysis was conducted in Chapter 2, a grounded theory approach to data analysis was conducted in Chapter 3, and a logistic regression analysis was conducted on non-fatal opioid overdose and its association with SUD treatment in Chapter 4.

    Results: In Chapter 2, five themes were reported: 1) effectiveness of the ACA for the treatment of an SUD, 2) unintended effects of the policy, 3) effect of the policy on different groups, 4) medication-assisted treatment, 5) and solution to the problem. In Chapter 3, four themes emerged:1) patient brokering, 2) financial enticements, 3) drug use to get into treatment and, 4) opioid overdose risk. In Chapter 4, first using an opioid drug by non-oral methods, methadone detox, buprenorphine detox, and 12 step attendance were found to be positively associated with lifetime non-fatal opioid overdose.

    Conclusions: While the ACA has increased access to SUD treatment, the unethical and sometimes illegal practices in the SUD treatment environment may have decreased its effectiveness. Furthermore, some types of SUD treatment may increase the risk of an overdose. This dissertation is an important contribution to the field because it will inform future policy decisions.

      Cover page: The Affordable Care Act, Substance Use Disorder Treatment, and Opioid Overdoses in Southern California: A Multiple Perspective Approach
      • Thesis
      • Peer Reviewed
      UC San Diego Electronic Theses and Dissertations (2017)

      Background: The treatment of substance use disorders, as any other form of medical care, is a human right and must comply with quality standards of health care, including the right to refuse use of services. Involuntary drug treatment has been reported ineffective in decreasing drug use but its effects on health and subsequent treatment-seeking have not been longitudinally assessed.

      Aims: (1) To examine the dynamics of involuntary drug treatment from the perspectives of people who inject drugs (PWID); (2) to assess the effect of involuntary drug treatment on non-fatal overdose; and (3) to determine whether past experiences of involuntary drug treatment influence subsequent voluntary treatment-seeking behavior in Tijuana, Baja California, Mexico.

      Methods: PWID who were at least 18-years old and reported injecting drugs in the prior month were enrolled in a prospective study. Participants completed interviewer-administered surveys at baseline and every six months (2011-2017). For Chapters 2 and 4, a subsample of PWID reporting involuntary drug treatment in the context of a federally-funded policing program was interviewed and thematic analysis was performed. In Chapter 3, generalized estimating equation analyses were conducted on recent (i.e., past 6 months) non-fatal overdose event and its relationship to involuntary drug treatment. In Chapter 4, Cox regression was also conducted to identify factors related to voluntary drug treatment subsequent to involuntary drug treatment experience among those with no prior drug treatment history.

      Results: In Chapter 2, 25 PWID described punitive characteristics of a local policing program and lack of State oversight and healthcare at drug centers. In Chapter 3, among 670 PWID, 31.5% reported a recent non-fatal overdose, which was independently associated with recent involuntary drug treatment. In Chapter 4, among 359 PWID, a possible pathway through which involuntary drug treatment limits future treatment-seeking was identified through mistreatment, stigmatization and discrimination at drug centers.

      Conclusions: Findings highlight the use of involuntary treatment as a mechanism of control that may have life-threatening risks as well as a complexity of factors that drive drug treatment-seeking among PWID in Tijuana. Policy implications include the need to protect PWIDs’ right to choose the circumstances of treatment, for adequate professionalization and training of drug treatment staff, and for treatment centers’ oversight.

        Cover page: The impact of involuntary drug treatment on overdose, subsequent drug use and drug use treatment-seeking among people who inject drugs in Tijuana, Mexico
        • Peer Reviewed
        UC Davis Previously Published Works (2020)
        Paper presented at Proceedings 1992 Annual Conference American Holistic Veterinary Medical Association
          Cover page: Ethical and Legal Considerations
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2023)

          Background

          Opioid use and opioid overdose deaths are at an all-time high and evidence-based treatments for people with opioid use disorder (OUD) are underutilized. Therefore, we sought to understand experiences and perceptions of abuses in the for-profit substance use disorder treatment industry that could potentially put people with OUD at an increased risk for an overdose.

          Methods

          One-on-one semi-structured interviews were conducted from November 2018 to May 2019 in Southern California with 20 people with OUD and 20 professionals who work in the substance use disorder (SUD) treatment field. A grounded theory approach was conducted to discover emerging patterns from the data.

          Results

          Three major themes emerged:1) financial and material enticements, 2) encouraging substance use in the for-profit treatment sector, and 3) contributors to overdose risk. Participants reported that patient brokers would pay for plane tickets and offer financial incentives (e.g., money) to attract individuals to SUD treatment, capitalizing on insurance profits despite initial expenses. Participants reported being encouraged to use drugs before treatment to meet insurance conditions, thus jeopardizing genuine recovery efforts and adding to the temptation of drug use. Many participants linked patient brokering to increased overdose deaths, emphasizing the dangerous practices of brokers providing drugs, promoting relapse, and creating a revolving door of treatment, which compounds the overdose risk after periods of abstinence.

          Conclusions

          Patient brokering and unethical abuses in the for-profit treatment industry have caused some people with OUD to seek treatment for money and housing instead of seeking treatment to stop opioid use. The harmful treatment environment was seen as a barrier to care and an unwanted obstacle to overcome on the path to recovery.
            Cover page: Patient brokering in for-profit substance use disorder treatment: a qualitative study with people with opioid use disorder and professionals in the fieldCreative Commons 'BY-NC-ND' version 4.0 license
            • Article
            • Peer Reviewed
            UC San Francisco Previously Published Works (2013)

            Background

            Heavy alcohol consumption has been associated with risk-taking behaviors in intravenous drug users (IDU). However, limited information exists on the relationship between alcohol use and injecting and sexual risk in young adult IDU (<30 years) who are at risk for hepatitis C virus (HCV) and HIV infection.

            Methods

            We conducted a cross-sectional study of young adult IDU in San Francisco (2006-2012) who had not previously tested positive for HCV. Participants completed a structured interview and HCV testing. We examined whether hazardous drinking (Alcohol Use Disorders Test-Consumption [AUDIT-C] 3-9 for women and 4-9 for men) and probable dependent drinking (AUDIT-C 10-12) levels were associated with injecting and sexual risk behaviors and HCV status, indicated by adjusted odds ratios (AOR) in separate models controlling for potential confounders.

            Results

            Of the 326 participants, 139 (42.6%) were hazardous drinkers and 82 (25.2%) were probable dependent drinkers; thus over two-thirds evidenced problem drinking. Being a hazardous drinker was significantly associated with injecting drug residue from another's drug preparation equipment (AOR 1.93). Probable dependent drinking was significantly associated with sharing non-sterile drug preparation equipment (AOR 2.59), and inversely, with daily/near daily injecting (AOR 0.42). Both heavy drinking levels were associated with having ≥2 sexual partners (AOR 2.43 and 2.14). Drinking category was not associated with HCV test results.

            Conclusion

            The young adult IDU reported consuming alcohol at very high levels, which was associated with some unsafe sexual and injecting behaviors. Our study demonstrates the urgent need to intervene to reduce alcohol consumption in this population.
              Cover page: Hazardous alcohol consumption among young adult IDU and its association with high risk behaviors
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2023)

              Background

              Drug overdoses are the leading cause of injury death in the United States with an estimated 105,752 individuals dying from an overdose in the United States in a 12-month period ending October 2021. Given that people who have opioid use disorder (OUD) are at an increased risk of death, it is crucial to assess risk factors associated with opioid overdose to improve interventions.

              Objectives

              We examine factors associated with non-fatal overdose among a suburban/exurban population with OUD in Southern California.

              Methods

              Participants were recruited by convenience sampling (n = 355) and were interviewed between November 2017 to August 2018. Participants were eligible for the study if they had a history of pharmaceutical opioid use.

              Results

              A total of 198 (55.8%) participants reported at least one overdose in their lifetime. A total of 229 participants identified as male, 124 identified as female, and 2 identified as non-binary. When controlling for demographic factors, non-oral opioid administration at first opioid use (AOR 2.82, 95% CI 1.52-5.22), having a history of methadone detoxification, (AOR 2.23, 95% CI 1.27-3.91), history of buprenorphine detoxification (AOR 1.77, 95% CI 1.02-3.07), and history of 12 step attendance (AOR 1.89, 95% CI 1.12-3.20) were found to be independently and positively associated with lifetime opioid overdose.

              Conclusions

              Detoxification with buprenorphine and methadone was found to be associated with having a non-fatal opioid overdose. Buprenorphine and methadone should not be prescribed as a detoxification medication as long-term use of medication for OUD results in better outcomes than medication that is used short-term.
                Cover page: Detoxification, 12-step meeting attendance, and non-fatal opioid overdoses among a suburban/exurban population with opioid use disorder
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2019)
                  Cover page: “Somebody Is Gonna Be Hurt”: Involuntary Drug Treatment in Mexico
                  • Article
                  • Peer Reviewed
                  UC San Francisco Previously Published Works (2013)
                  Young injection drug users (IDUs), a highly mobile population, engage in high levels of injecting risk behavior, yet little is understood about how such risk behavior may vary by the characteristics of the cities to which they travel, including the existence of a syringe exchange program (SEP), as well as travel partner characteristics. In 2004-2005, we conducted a 6-month prospective study to investigate the risk behavior of 89 young IDUs as they traveled, with detailed information gathered about 350 city visits. In multivariable analyses, travel to larger urban cities with a population of 500,000-1,000,000 was significantly associated with injecting drugs (adjusted odds ratio (AOR) = 3.71; 95 % confidence interval (CI), 1.56-8.82), ancillary equipment sharing (AES; AOR = 7.05; 95 % CI, 2.25-22.06) and receptive needle sharing (RNS; AOR = 5.73; 95 % CI, 1.11-27.95), as compared with visits to smaller cities with populations below 50,000. Region of the country, and the existence of a SEP within the city visited, were not independently associated with injecting drugs, AES, or RNS during city visits. Traveling with more than one injecting partner was associated with injecting drugs during city visits (AOR = 2.77; 95 % CI, 1.46-5.27), when compared with traveling alone. Additionally, both non-daily and daily/almost daily alcohol use during city visits were associated with AES (AOR = 3.37; 95 % CI, 1.42-7.68; AOR = 3.03; 95 % CI, 1.32-6.97, respectively) as compared with no alcohol consumption. Traveling young IDUs are more likely to inject when traveling with other IDUs and to engage in higher risk injection behavior when they are in large cities. Risk behavior occurring in city visits, including equipment sharing and alcohol consumption, suggests further need for focused interventions to reduce risk for viral infection among this population.
                    Cover page: Injecting Risk Behavior among Traveling Young Injection Drug Users: Travel Partner and City Characteristics
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2022)

                    Background

                    Safe consumption sites (SCS) are an evidence-based intervention to prevent drug use-related harm. In late 2014, an organisation in an undisclosed location in the USA opened an unsanctioned SCS.

                    Objective

                    To evaluate whether use of the unsanctioned SCS affected medical outcomes.

                    Design

                    A prospective cohort study.

                    Setting

                    Neighbourhoods surrounding the SCS.

                    Participants

                    People who injected drugs were recruited and interviewed at baseline and 6 and 12 months from 2018 to 2020.

                    Intervention

                    People using the SCS could bring pre-obtained drugs to consume via injection, which were monitored by trained staff with naloxone.

                    Main measures

                    Any overdose, number of non-fatal overdoses, skin and soft tissue infections, emergency department utilisation, number of emergency department visits, hospitalisation and number of nights spent in hospital.

                    Key results

                    A total of 494 participants enrolled in the study; 59 (12%) used the SCS at least once. We used propensity score weighting to analyse the association between SCS utilisation and measures. People using the SCS were 27% (95% CI: 12-46%) less likely to visit the emergency department, had 54% (95% CI: 33-71%) fewer emergency department visits, were 32% (95% CI: 4-57%) less likely to be hospitalised, and spent 50% (95% CI: 1-85%) fewer nights in hospital. Though not significant, people using the SCS had a lower likelihood of overdosing and slightly higher likelihood of skin and soft tissue infections.

                    Conclusions

                    Our findings support the use of SCS in the USA to reduce the growing burden of acute care service utilisation related to injection drug use.
                      Cover page: Reduced Emergency Department Visits and Hospitalisation with Use of an Unsanctioned Safe Consumption Site for Injection Drug Use in the United StatesCreative Commons 'BY' version 4.0 license
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