Factors Affecting Repeated Cessations of Injecting Drug Use and Relapses During the Entire Injecting Career Among the Edinburgh Addiction Cohort

Overview

Journal Drug Alcohol Depend

Publisher Elsevier

Specialty Psychiatry

Date 2015 Apr 15

PMID 25869544

Citations 19

Authors

Yang Xia

Shaun Seaman

Matthew Hickman

John Macleod

Roy Robertson

Lorraine Copeland

Jim McKenzie

Daniela De Angelis

Affiliations

Soon will be listed here.

Abstract

Background And Aims: Injecting drug use is a chronic condition, with people who inject drugs (PWID) typically experiencing repeated cessations and relapses during their injection careers. We characterize patterns of ceasing and relapsing and the impact of opiate substitution treatment (OST) during the entire injecting careers of PWID in the Edinburgh Addiction Cohort (EAC).

Methods: During 2005-2007, 432 surviving participants of the EAC were interviewed about their injecting histories. Adjusted associations between covariates and hazards of cessation and relapse were estimated using random-effects models.

Results: OST was strongly associated with a higher hazard of cessation (HR = 1 .71, P < 0.001), but there was no significant evidence of association with hazard of relapse (HR = 0.81, P = 0.14). Women and older PWID were less likely to relapse (HR = 0.73, P = 0.02 and HR = 0.55, P < 0.001, respectively). Hazards of both cessation and relapse decreased monotonically with time since last relapse/cessation (both P < 0.001). An individual's hazard of cessation increased with his/her number of previous cessations (HR = 3.58 for 10+ previous cessations, P < 0.001), but there was no evidence that an individual's hazard of relapse changed with number of previous relapses (P = 0.37). There was heterogeneity in the individual hazards of both cessation and relapse.

Conclusions: OST was associated with reduced time to cessation, and there was some suggestion of increased time to relapse too. The likelihood of prolonged cessation is greater for women, increases with age, and decreases with time since last relapse.

Citing Articles

Testing and Treatment Interventions in Community Settings Key to Controlling a Recent Human Immunodeficiency Virus Outbreak Among People Who Inject Drugs in Glasgow: A Modeling Study.

Allen L, Fraser H, Stone J, McAuley A, Trayner K, Metcalfe R J Infect Dis. 2024; 230(1):e48-e59.

PMID: 39052745 PMC: 11272080. DOI: 10.1093/infdis/jiae206.

Modeling the impact of the COVID-19 pandemic on achieving HCV elimination amongst young and unstably housed people who inject drugs in San Francisco.

Fraser H, Stone J, Facente S, Artenie A, Patel S, Wilson E Int J Drug Policy. 2024; 131:104452.

PMID: 38910096 PMC: 7617003. DOI: 10.1016/j.drugpo.2024.104452.

Injection cessation and relapse to injection and the associated factors among people who inject drugs in Iran: The Rostam study.

Mehmandoost S, Mirzazadeh A, Karamouzian M, Khezri M, Sharafi H, Shahesmaeili A Subst Abuse Treat Prev Policy. 2023; 18(1):72.

PMID: 38031110 PMC: 10687883. DOI: 10.1186/s13011-023-00583-6.

6th Canadian Symposium on Hepatitis C Virus: Delivering a cure for hepatitis C infection-What are the remaining gaps?.

Khan S, Bernier A, Dapp D, Fortier E, Krajden M, King A Can Liver J. 2022; 1(2):94-105.

PMID: 35990718 PMC: 9202794. DOI: 10.3138/canlivj.1.2.008.

High rates of resumption of injecting drug use following release from prison among men who injected drugs before imprisonment.

Curtis M, Winter R, Dietze P, Wilkinson A, Cossar R, Stewart A Addiction. 2022; 117(11):2887-2898.

PMID: 35665554 PMC: 9796148. DOI: 10.1111/add.15971.

References

Gowing L, Farrell M, Bornemann R, Sullivan L, Ali R . Substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev. 2008; (2):CD004145. DOI: 10.1002/14651858.CD004145.pub3. View

Copeland L, Budd J, Robertson J, Elton R . Changing patterns in causes of death in a cohort of injecting drug users, 1980-2001. Arch Intern Med. 2004; 164(11):1214-20. DOI: 10.1001/archinte.164.11.1214. View

MADDUX J, Desmond D . New light on the maturing out hypothesis in opioid dependence. Bull Narc. 1980; 32(1):15-25. View

Turner K, Hutchinson S, Vickerman P, Hope V, Craine N, Palmateer N . The impact of needle and syringe provision and opiate substitution therapy on the incidence of hepatitis C virus in injecting drug users: pooling of UK evidence. Addiction. 2011; 106(11):1978-88. DOI: 10.1111/j.1360-0443.2011.03515.x. View

OBrien C . Addiction and dependence in DSM-V. Addiction. 2011; 106(5):866-7. PMC: 3812919. DOI: 10.1111/j.1360-0443.2010.03144.x. View

Gossop M, Trakada K, Stewart D, Witton J . Reductions in criminal convictions after addiction treatment: 5-year follow-up. Drug Alcohol Depend. 2005; 79(3):295-302. DOI: 10.1016/j.drugalcdep.2005.01.023. View

van den Berg C, Smit C, van Brussel G, Coutinho R, Prins M . Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. Addiction. 2007; 102(9):1454-62. PMC: 2040242. DOI: 10.1111/j.1360-0443.2007.01912.x. View

Mathers B, Degenhardt L, Ali H, Wiessing L, Hickman M, Mattick R . HIV prevention, treatment, and care services for people who inject drugs: a systematic review of global, regional, and national coverage. Lancet. 2010; 375(9719):1014-28. DOI: 10.1016/S0140-6736(10)60232-2. View

Kimber J, Copeland L, Hickman M, Macleod J, McKenzie J, De Angelis D . Survival and cessation in injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment. BMJ. 2010; 341:c3172. PMC: 2895695. DOI: 10.1136/bmj.c3172. View

10.

ZINBERG N, Jacobson R . The natural history of "chipping". Am J Psychiatry. 1976; 133(1):37-40. DOI: 10.1176/ajp.133.1.37. View

11.

Vlahov D, Anthony J, Munoz A, Margolick J, Nelson K, Celentano D . The ALIVE study, a longitudinal study of HIV-1 infection in intravenous drug users: description of methods and characteristics of participants. NIDA Res Monogr. 1991; 109:75-100. View

12.

Macleod J, Copeland L, Hickman M, McKenzie J, Kimber J, De Angelis D . The Edinburgh Addiction Cohort: recruitment and follow-up of a primary care based sample of injection drug users and non drug-injecting controls. BMC Public Health. 2010; 10:101. PMC: 2841670. DOI: 10.1186/1471-2458-10-101. View

13.

Goldstein A, Herrera J . Heroin addicts and methadone treatment in Albuquerque: a 22-year follow-up. Drug Alcohol Depend. 1995; 40(2):139-50. DOI: 10.1016/0376-8716(95)01205-2. View

14.

Hser Y, Hoffman V, Grella C, Anglin M . A 33-year follow-up of narcotics addicts. Arch Gen Psychiatry. 2001; 58(5):503-8. DOI: 10.1001/archpsyc.58.5.503. View

15.

Degenhardt L, Mathers B, Vickerman P, Rhodes T, Latkin C, Hickman M . Prevention of HIV infection for people who inject drugs: why individual, structural, and combination approaches are needed. Lancet. 2010; 376(9737):285-301. DOI: 10.1016/S0140-6736(10)60742-8. View

16.

HARDING W, ZINBERG N, Stelmack S, Barry M . Formerly-addicted-now-controlled opiate users. Int J Addict. 1980; 15(1):47-60. DOI: 10.3109/10826087109045543. View

17.

Rathod N, Addenbrooke W, Rosenbach A . Heroin dependence in an English town: 33-year follow-up. Br J Psychiatry. 2005; 187:421-5. DOI: 10.1192/bjp.187.5.421. View

18.

De Angelis D, Sweeting M, Ades A, Hickman M, Hope V, Ramsay M . An evidence synthesis approach to estimating Hepatitis C prevalence in England and Wales. Stat Methods Med Res. 2008; 18(4):361-79. DOI: 10.1177/0962280208094691. View

19.

Termorshuizen F, Krol A, Prins M, Geskus R, van den Brink W, van Ameijden E . Prediction of relapse to frequent heroin use and the role of methadone prescription: an analysis of the Amsterdam Cohort Study among drug users. Drug Alcohol Depend. 2005; 79(2):231-40. DOI: 10.1016/j.drugalcdep.2005.01.013. View

20.

Seaman S, Pavlou M, Copas A . Review of methods for handling confounding by cluster and informative cluster size in clustered data. Stat Med. 2014; 33(30):5371-87. PMC: 4320764. DOI: 10.1002/sim.6277. View