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Fluctuations in the use of many drugs at one time or another have been characterized as drug epidemics. The depiction of drug use as an epidemic, as in the recent cases of methamphetamine and crack use, is a proven mechanism for communicating that a problem exists, but such depictions are not without risk. When the public characterization of drug use as an epidemic represents more than its epidemiological meaning of iunusually elevated occurrence, i panic is often substituted for reasoned action. Such declarations are likely to truncate objective investigation, generate fear rather than understanding, and stimulate reactive measures that exacerbate drug misuse. This article discusses the epidemiological origin and meaning of epidemic, documents how media headlines have sensationally depicted methamphetamine use, and recommends that alternative strategies for describing an increase in the incidence and prevalence of use may be more successful in directing researchers and policy makers toward effective strategies for reducing misuse.

The present study examines violent victimization among a sample of active drug users. Two theoretical perspectives are combined to form the underlying conceptual framework of the study: One draws upon routine activities/lifestyle theory and the other incorporates the street addict role theory. While routine activities/lifestyle theory addresses victimization in general, the street addict role theory explains the specific lifestyle characteristics of an active drug abuser which are relevant to the victimization of illicit drug users. We find the prevalence of violent victimization to be high. Approximately 22% of respondents reported being victimized within a 30 day period. We also find support for combining the two perspectives to help explain violent victimization. Demographic, personal networks, drug use, and street business domain factors are associated with violent victimization for this high risk population. Our study extends the investigation of violent victimization among illicit drug users by identifying characteristics that differentiate drug users who are recent victims of violence from others who have not been similarly victimized.

The association between religiosity and reduced alcohol and drug use in the general population is commonly recognized, but research about the relationship between religiosity and drug-related risk behaviors among illicit drug users has received considerably less attention. This study explores the role of religiosity in explaining heavy polydrug use and other HIV-related risk behaviors among a tri-ethnic sample of 600 male and female active heroin injectors who were recruited from the streets of Miami-Dade County, Florida. The effects of three dimensions of religiosity on heavy alcohol use, daily crack-cocaine use, and five HIV-related injection and sex risk behaviors were assessed using multivariate logistic regression techniques that controlled for demographics and self-reported HIV serostatus. The majority of heroin injectors reported some degree of religiosity as expressed by religious intentionality, worship attendance, and religious self-perception. Strong religious intentionality was associated with a decreased likelihood of reusing needles/syringes, but the regression results suggest that religiosity for the most part did not influence heavy polydrug use or other HIV-related risk behaviors of active heroin injectors.

This paper contains a systematic review of articles about the relationship between religiosity/spirituality and alcohol and drug use that were published between 1997 and 2006. Summaries of methodological characteristics (e.g., study design, sample size and composition, specific dimensions of religiosity, and substances investigated) and general findings of 105 studies provide an overview of the field. The association between religiosity/spirituality and reduced risk of substance use is well established, but a well defined body of knowledge on this relationship has been slow to emerge. The development of more sophisticated instrumentation to measure religiosity and spirituality, the investigation of samples that include users of major drugs of abuse, and the integration of the study of religion and drug use into the broader literature on religion and health can help the field build upon the considerable work that has been published.

Injection drug users are at risk for a variety of infections when hygienic injection practices are not performed. Disinfecting the injection site prior to injecting reduces the risk of bacterial infections but has been overlooked in many prevention efforts. Using what is known about factors associated with risk-reduction behaviors of disinfecting equipment, we evaluated a model to determine whether those factors are associated with disinfection of the injection site. Sociodemographic and behavioral data were collected in interviews with 600 injection drug users. The majority of injection drug users do not clean the injection site prior to injecting. Results indicate that gender, ethnicity, and frequency of injection were significantly related to whether or not an injector cleaned the injection site. Failure to clean the injection site prior to injecting is a common practice and constitutes a health risk among injection drug users, particularly in a population prone to other infections. Prevention efforts need to incorporate aft levels of sterilization procedures when working with these high risk populations.

The purpose of this paper is to characterize persons who sniff heroin by examining their experiences prior to first heroin use, experiences at first use, current drug use patterns, and factors associated with progression to the daily use of heroin. Relatively little has been published about the lives and career trajectories of heroin sniffers who have little or no history of drug injection. A sample of 250 African-American, Hispanic/Latino, and non-Hispanic White men and women who sniffed heroin were interviewed for this study. Most people first sniffed heroin in a social setting where heroin use was not preplanned. Heroin sniffing has become a sustained pattern of use for many of these users; the majority have progressed to daily sniffing of heroin and are polydrug users for whom crack is an important substance; and heroin sniffers have experienced a range of life and health problems including a high prevalence of HIV.

We explore the relationship between contact with treatment and transition to injection for heroin sniffers. Our primary research question is, does contact with treatment delay onset of injection for heroin sniffers? A stratified network-based sample was recruited from multiple communities in South Florida which were known for high drug use. Three categories of respondents were recruited based on injection outcome: long-term injectors, short-term injectors, and sniffers (n = 900). We answer our research question in two steps. First, we investigate the prevalence of drug treatment for heroin sniffers and injectors using case-control methods. The preliminary findings indicate a positive relationship between contact with treatment and injection status outcome. Second, we further examine the relationship by attempting to identify the causal factors that delay initial injection for a subgroup of current injectors using survival regression procedures. Delaying or preventing transition to injection could significantly decrease risk of HIV transmission by reducing or eliminating risky injecting behaviors. We conclude with a discussion of policy implications and suggestions for future research. Keywords: Drug treatment; HIV/AIDS; Transition to injection; Heroin; Heroin sniffers; USA

ABBREVIATIONS. PCS, Prenatal Cocaine Study; HIV, human immunodeficiency virus; SD, standard deviation; ATM, alcohol, tobacco, and marijuana; EMIT, enzyme-mediated immunoassay technique; GC/MS, gas chromatography/mass spectrometry; MIMIC, Multiple Indicators, Multiple Causes; [...], Objective. The objectives of this study were to estimate the effect of prenatal cocaine exposure on fetal growth and gestational age after controlling for exposure to alcohol, tobacco, and marijuana and other covariates; to evaluate whether prenatal cocaine exposure has a disproportionate adverse effect on head circumference compared with overall somatic growth; and to assess whether the effect of prenatal cocaine exposure on fetal growth is mediated by cocaine's suspected effect on gestational age. Methods. The study population includes 476 neonates participating in the Miami Prenatal Cocaine Study, a longitudinal follow-up of in utero cocaine exposure. The sample, restricted to full-term neonates born to African-American inner-city mothers, included 253 infants exposed prenatally to cocaine (with or without alcohol, tobacco, or marijuana exposure) and 223 non-cocaine-exposed infants, of whom 147 were drug-free and 76 were exposed to varying combinations of alcohol, tobacco, or marijuana. Results. Evidence based on structural equations and multiple regression models supports a hypothesis of cocaine-associated fetal growth deficits (0.63 standard deviation) and an independent mild effect on gestational age (0.33 standard deviation). There was no evidence of a disproportionate adverse effect on birth head circumference once the impact on overall growth was estimated. There was evidence that some but not all of the cocaine effect on fetal growth was direct and some was indirect, acting via an intermediate influence of cocaine on gestational age. Conclusions. Cocaine-associated growth deficits, symmetrical and partially mediated by gestational age, were observed in this sample of inner-city African-American full-term infants prospectively enrolled at birth. Long-term implications will be the subject of future reports from this longitudinal investigation. Pediatrics 2001;108:1309-1319; cocaine, crack, prenatal, infant, growth.

Few studies have examined the relationships between drug use, health services utilization and the cost of medical care for a community-based sample of drug users. The purpose of this study was to analyze recently collected data on chronic drug users (CDUs), CDUs who were also injecting drug users (IDUs) and non-drug users (NDUs) to determine whether these groups exhibited differences in health services utilization and cost. In addition to descriptive analyses, these relationships were estimated with multivariate regression models. Data were collected in 1996 and 1997 through a standardized self-reported questionnaire administered to individuals who were recruited through community outreach activities in the USA. Annual differences in health services utilization between CDUs, IDUs and NDUs were estimated for three measures: number of times admitted to a hospital, number of outpatient visits and number of emergency room episodes. Results of this study indicate that CDUs and IDUs consumed significantly more inpatient and emergency care, but less outpatient services relative to NDUs. Analyses of total health care costs showed that CDUs and IDUs each generated about $1000 in excess services utilization per individual relative to NDUs. This research is the first study to compare differences in health services utilization and cost among out-oftreatment drug users relative to a matched group of non-users in a community-based setting. The findings suggest that health care providers and managed care organizations should consider policies that promote more ambulatory care and discourage emergency room and inpatient care among drug users. Innovative and culturally acceptable approaches may be necessary to provide incentives without posing unusual financial hardship.

The organization and delivery of medical care are undergoing a major transformation in the United States. Today, only a minority of the people in this nation still receive their health [...], This article compares the health care need and health care use of injection drug users, other chronic drug users, and nondrug users. Data from 1,330 non-Hispanic White, African American, and Hispanic/Latino men and women were analyzed to determine independent risk factors for two outcome variables: (a) need for health care treatment and (b) use of health care treatment. Ten independent demographic, health, and drug use variables were assessed in logistic regression models. Drug use (injection drug use or other chronic drug use), being female, having insurance, and perceived health status of very good/good or fair/poor were independently associated with increased need.for health care. Injection drug use and other chronic drug use decreased the likelihood of receiving health care treatment, whereas being female, having, insurance, and a perceived health status of fair/poor increased the likelihood of receiving health care.

This study uses routine activity theory to examine violent and property crime victimization among a sample of 308 injection drug users (IDUs). We estimate prevalence rates and identify factors that contribute to the victimization of IDUs. The findings suggest that victimization rates of IDUs were much higher than rates found for the general urban population. Generally, crime involvement did not contribute significantly to victimization risk. Use of crack-cocaine increased the likelihood of property crime victimization whereas heroin use decreased the probability of both violent and property crime victimization. Other drug lifestyle activities (i.e., waiting in uncomfortable situations to buy drugs) also affected victimization risk. Finally, the results suggest that victimization differed by age and by gender, despite controls for drug use and drug lifestyle activities. Explanations for these results are offered.

Sharing needles among injection drug users appears to be associated with becoming infected with HIV. Researchers compared 21 injection drug users who became infected with HIV while they were tracked over a two-year period with 76 similar persons who remained HIV negative. Injection drug users who became infected were four times more likely to have shared needles and syringes during the previous year than the noninfected group. Contracting a sexually transmitted disease during the previous year was marginally significant. African American descent was significant even after adjusting for behavioral and demographic factors. Programs to reduce HIV transmission among injection drug users should focus on reducing sharing of syringes and needles in addition to promoting safer sexual practices.

Injection drug users may have fairly consistent memory recall of their HIV risk behaviors over time. A group of 366 injection drug users was asked to remember four HIV risk behaviors they had reported 6, 12, and 18 months earlier. Variability of self-reported injection frequency, needle sharing, number of sexual partners, and condom use over a period of time would indicate unreliable recall. Data suggest that this group of drug users experienced a small initial memory loss but no recall changes after 6 months. Drug users may be less hesitant to reveal socially unacceptable risk behaviors in the distant past. Consistency of self-reported behavior may not rule out untruthful reporting on the individual's part. However, retrospective reports may be of continued value in HIV risk research, especially in the absence of other data.

A survey of African Americans, Hispanics and white, non-Hispanics reveals that the pattern of injection drug use depends on ethnicity. The drugs were obtained by different ethnic groups from different sources. Anglos obtained drugs from medicine shops, physicians or through relatives and friends. Hispanics obtained drugs from street vendors. African American women obtained drugs from street vendors. The preparation of drugs and its injection causes the spread of AIDS and other sexually transmitted diseases.

Objectives. This study was designed to assess and compare sex risk behaviors for human immunodeficiency virus (HIV) transmission of three drug user groups: injectors who do not smoke crack, crack smokers who do not inject, and injectors who also smoke crack. Methods. Sexual risk behaviors for HIV were assessed among 246 drug users from Denver, Miami, and San Francisco. Respondents were classified into the three drug groups based on self-report and verified through urinalysis and physical inspection. Results. An increased risk for HIV through sexual transmission was associated with crack cocaine use, particularly among those who also injected. Crack smoking injectors were more likely to report sex with an injector, exchanging sex for drugs and/or money, drug use before or during sex, and unprotected sexual intercourse. They also injected more than injectors only, smoked crack as often as smokers only, and reported higher overall frequencies of drug use. Conclusions. These findings, together with the higher rates of gonorrhea and syphilis reported by smokers and injectors/smokers, are indicators of the risk crack poses for the heterosexual transmission of HIV., Participation in sexual behavior that raises the risk of HIV infection appears to be more common among injection drugs users who smoke crack cocaine than in other kinds of drug users. Three categories of drug users were studied in Denver, Miami and San Francisco. The groups consisted of 108 people who both smoked crack cocaine and injected drugs, 81 injectors who did not smoke crack, and 57 crack smokers who did not inject drugs. An increased risk of sexually transmitted HIV was associated with crack cocaine use, especially among those who also injected. Injectors who smoked crack were more likely to have had sex with another injector to obtain drugs and/or money. Crack smoking injectors also injected more than injectors only, smoked crack as frequently as smokers only and made greater use of drugs overall. The findings indicate that crack constitutes a risk for heterosexual HIV transmission.

An unprecedented number of human sexuality studies have been initiated in response to the acquired immune deficiency syndrome (AIDS) epidemic. Unfortunately, methodological developments in the field of sex research have been slow in meeting the demands of AIDS investigations focusing on the diverse populations at risk for infection with the human immunodeficiency virus (e.g., adolescents, gay men, intravenous-drug users, ethnic minorities, elderly transfusees). In this article, we review and integrate current literature on measurement error and participation bias in sex research, with an emphasis on collecting sexual information in the context of AIDS. The relevance of these findings for AIDS-related sex research is discussed, and recommendations are made to guide future investigations.

Intravenous drug users (IVDUs) have high rates of infection by human immunodeficiency virus (HIV-1, which causes AIDS) and other agents, such as human lymphotropic viruses I and II (HTLV-I and -II, which attack white blood cells). Although blood donation by this group is not allowed, the screening of potential donors is still based primarily on self-reports. Therefore, IVDUs can continue to donate and sell their blood, and research studies have found that, in some regions, as many as 27 percent have done so in recent years. To learn more concerning the seroprevalence (positive antibody blood tests, which indicate infection) of HIV-1 and HTLV-I and -II among IVDUs in Dade County, Florida, 915 IVDUs (704 from drug treatment programs, and 211 recruited from the street) were assessed between June 1987 and August 1988. This county has the greatest number of AIDS cases due to intravenous drug use in the US. Subjects were tested for HIV, offered counseling, and asked to complete a questionnaire concerning, in part, items about the sale or donation of blood. Results showed that 153 IVDUs (16.7 percent) had donated or sold blood since January 1, 1985. Four-fifths of the blood donations involved the sale of blood. Slightly more than 22 percent of the entire group tested positive for HIV-1; the HIV seropositivity rate for those who had sold or given blood was 19.6 percent. Tests for HTLV-I or HTLV-II were positive for 5.7 percent of those who donated blood. Blood donation and sale were more common among males than females, and among those who were not in treatment programs. Fewer of those in treatment than on the street had sold blood, 68.5 percent versus 98.8 percent. Screening donated blood for HIV antibodies has reduced, but not eliminated, the risk of disease transmission. Infection with the virus precedes the appearance of antibodies in the blood, so it is not always possible, even with testing, to guarantee freedom from contamination. The results indicate that commercial blood donation centers, often located in inner-city neighborhoods, must become more selective and more skilled at screening would-be donors. One step that must be taken is the employment of people who can identify IVDUs from signs such as needle track marks. (Consumer Summary produced by Reliance Medical Information, Inc.)

'Shooting galleries' are places where intravenous (IV) drug users can rent injection equipment. In addition to the equipment, the shooting galleries provide a location for the communal use of IV drugs. Frequently, needles are shared without being sterilized between users; this practice has been recognized as a significant factor in the spread of AIDS, acquired immunodeficiency syndrome. Needles from three shooting galleries in the Miami, Florida area were examined. Of 50 needles tested that appeared to contain blood residue, 20 percent tested positive for the HIV-1 (human immunodeficiency virus type 1) antibody; of the 98 needles without visible blood, 5.1 percent tested positive for HIV-1. Overall, 10.1 percent of the 148 needles tested were positive for HIV-1 antibodies, confirming the epidemiologic evidence that the use of needles from shooting galleries can transmit HIV-1. The research also confirms that even if the needles appear clean, they may be contaminated. Typically any cleaning of the needles in shooting galleries is performed after use rather than prior to use, and much of the cleaning consists of simple rinsing, rather than bleaching or sterilization. This study illustrates the importance of educating users and gallery operators about proper cleaning techniques for needles and syringes. (Consumer Summary produced by Reliance Medical Information, Inc.)