UBC Faculty Research and Publications

Overdose experiences among injection drug users in Bangkok, Thailand Milloy, M-J; Fairbairn, Nadia; Hayashi, Kanna; Suwannawong, Paisan; Kaplan, Karyn; Wood, Evan; Kerr, Thomas May 13, 2010

Your browser doesn't seem to have a PDF viewer, please download the PDF to view this item.

Item Metadata

Download

Media
52383-12954_2009_Article_177.pdf [ 595.78kB ]
Metadata
JSON: 52383-1.0223549.json
JSON-LD: 52383-1.0223549-ld.json
RDF/XML (Pretty): 52383-1.0223549-rdf.xml
RDF/JSON: 52383-1.0223549-rdf.json
Turtle: 52383-1.0223549-turtle.txt
N-Triples: 52383-1.0223549-rdf-ntriples.txt
Original Record: 52383-1.0223549-source.json
Full Text
52383-1.0223549-fulltext.txt
Citation
52383-1.0223549.ris

Full Text

Milloy et al. Harm Reduction Journal 2010, 7:9http://www.harmreductionjournal.com/content/7/1/9Open AccessR E S E A R C HResearchOverdose experiences among injection drug users in Bangkok, ThailandM-J Milloy†1, Nadia Fairbairn†2, Kanna Hayashi†2, Paisan Suwannawong†3, Karyn Kaplan†3, Evan Wood†2,4 and Thomas Kerr*†2,4AbstractBackground: Although previous studies have identified high levels of drug-related harm in Thailand, little is known about illicit drug overdose experiences among Thai drug users. We sought to investigate non-fatal overdose experiences and responses to overdose among a community-recruited sample of injection drug users (IDU) in Bangkok, Thailand.Methods: Data for these analyses came from IDU participating in the Mit Sampan Community Research Project. The primary outcome of interest was a self-reported history of non-fatal overdose. We calculated the prevalence of past overdose and estimated its relationship with individual, drug-using, social, and structural factors using multivariate logistic regression. We also assessed the prevalence of ever witnessing an overdose and patterns of response to overdose.Results: These analyses included 252 individuals; their median age was 36.5 years (IQR: 29.0 - 44.0) and 66 (26.2%) were female. A history of non-fatal overdose was reported by 75 (29.8%) participants. In a multivariate model, reporting a history of overdose was independently associated with a history of incarceration (Adjusted Odds Ratio [AOR] = 3.83, 95% Confidence Interval [CI]: 1.52 - 9.65, p = 0.004) and reporting use of drugs in combination (AOR = 2.48, 95% CI: 1.16 - 5.33, p = 0.019). A majority (67.9%) reported a history of witnessing an overdose; most reported responding to the most recent overdose using first aid (79.5%).Conclusions: Experiencing and witnessing an overdose were common in this sample of Thai IDU. These findings support the need for increased provision of evidence-based responses to overdose including peer-based overdose interventions.BackgroundAccidental illicit drug-related overdose is a leading causeof preventable morbidity and mortality. In many settings,fatal overdose is the primary contributor to highly ele-vated mortality rates among injection drug users (IDU)[1,2]. According to several studies of community-recruited IDU, non-fatal overdose is common and associ-ated with factors including having a prior history of over-dose, recent incarceration and higher-intensity forms ofdrug use, such as poly-drug use [3-6]. Several interven-tions to lower the incidence or reduce the damagingsequelae of overdose events have been implemented,including treatment for drug use [7], drug substitutiontherapy [8], supervised injection facilities [9] and peer-driven responses, such as naloxone distribution [10].Despite reports of injection drug use from all majorregions of the world [11,12], the phenomenon of acciden-tal drug overdose has not been well described outside ofWestern settings. In northern Vietnam, over 80% of out-of-treatment male opiate injectors reported a history ofoverdose in a cross-sectional survey [13]. Overdose in theprevious 12 months was common among 731 IDU inSichuan province, China, and associated with daily her-oin use and an injection career of at least seven years induration [14].In Thailand, some aspects of drug-related harm,including high levels of incarceration [15], persecution by* Correspondence: uhri-tk@cfenet.ubc.ca2 British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 667-BioMed Central© 2010 Milloy et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative CommonsAttribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction inany medium, provided the original work is properly cited.police [16] and infection with HIV [17,18] hepatitis C [19]1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada† Contributed equallyFull list of author information is available at the end of the articleMilloy et al. Harm Reduction Journal 2010, 7:9http://www.harmreductionjournal.com/content/7/1/9Page 2 of 7and other pathogens [20] have been identified among theestimated 20,000 - 160,000 IDU in the country [11,12].However, we are unaware of any study that analyses thephenomenon of overdose among Thai drug users. Thus,we sought to estimate the prevalence and correlates ofnon-fatal overdose, as well as investigate patterns ofresponse to overdose in a community-recruited sample ofactive IDU in Bangkok, Thailand.MethodsData for these analyses was obtained from the Mit Sam-pan Community Research Project (MSCRP), a collabora-tive research effort involving the Mit Sampan HarmReduction Center (Bangkok, Thailand), the Thai AIDSTreatment Action Group (Bangkok, Thailand), Chula-longkorn University (Bangkok, Thailand) and the BritishColumbia Centre for Excellence in HIV/AIDS (Vancou-ver, Canada). In 2008, the research partners designed andundertook a cross-sectional epidemiological study of IDUrecruited through peer-based outreach and word-of-mouth. Invited participants were asked to attend the MitSampan Harm Reduction Center to be included in thestudy. All participants provided informed consent andcompleted an interviewer-administered questionnaire.The survey instrument elicited demographic data, infor-mation about past and current drug use, HIV risk behav-iour, overdose experiences, interactions with the criminaljustice system including police forces and incarceration,and experience with health care. Upon completion of thequestionnaire participants were provided a stipend of 250Thai baht. The study was approved by the research ethicsboards at the University of British Columbia and Chula-longkorn University.For these analyses, the primary endpoint of interest wasreporting a history of non-fatal overdose by answering"Yes" to the question: "Have you ever overdosed by acci-dent (i.e., a period of loss of consciousness or breathing?)"In follow-up questions, individuals reporting a history ofnon-fatal overdose were also asked the type of drug ordrugs they were using at the time of their last overdose, ifthey were helped, and by who, during their last overdose.As a first step, we investigated the characteristics ofindividuals with a history of overdose. Explanatory vari-ables included: Age; gender (male vs. female); educationlevel (<prathom suksa [elementary-level] vs. ≥ prathomsuksa); reporting any income from illegal sources (yes vs.no); participation in the sex trade (yes vs. no); history ofheroin injection (yes vs. no); history of Midazolam (abenzodiazepine) injection (yes vs. no); history of yaba(methamphetamine and caffeine) injection (yes vs. no);history of ice (methamphetamine) injection (yes vs. no);ever incarcerated (yes vs. no); ever on methadone mainte-nance therapy (MMT) (yes vs. no); and ever in forceddrug treatment (yes vs. no). Pearson's X2-test and Fisher'sexact test were used to determine bivariate relationships.Next, we used an a priori-defined statistical protocolbased on examination of the Akaike Information Crite-rion (AIC) and p-values to construct an explanatory mul-tivariate logistic regression model. First, we constructed afull model including all variables analysed in bivariateanalyses. After noting the AIC of the model, we removedthe variable with the largest p-value and built a reducedmodel. We continued this iterative process until no vari-ables remained for inclusion. We selected the multivari-ate model with the lowest AIC score.In a secondary analysis, all participants were asked ifthey had ever witnessed an overdose. Those with a his-tory of witnessing overdose were asked about theirresponse to the most recently witnessed overdose. Finally,all participants were asked if they believed they hadenough information to prevent and manage overdose andwhat steps they believe should be taken to effectivelymanage overdose.ResultsTwo-hundred fifty-two individuals were recruited andincluded in these analyses, of whom 66 (26.1%) werewomen. The median age at time of interview was 36.5years (IQR: 29.0 - 44.0 years.) In total, 75 participants(29.8%) reported a history of non-fatal overdose. Whenasked about the type and routes of administration of alldrugs consumed prior to their last overdose, almost all(70, 93.3%) reported injection heroin, followed by injec-tion Midazolam (24, 32.0%), non-injection heroin (11,14.7%) and non-injection midazolam (4, 5.3%). No otherresponse (including injection and non-injection yaba,non-injection ecstasy, injection and non-injection metha-done, injection and non-injection benzodiazepine andinjection and non-injection alcohol) exceeded three(4.0%) reports.Of the 75 participants with a history of overdose, 59(78.7%) reported being helped by another individual dur-ing their last overdose. Most reported being assisted by afriend (46, 78.0%), relative (11, 18.6%) or sex partner (3,5.1%). Of all individuals reporting an overdose, only 28(33.5%) reported being seen by a healthcare professional.Results of the univariate analyses of factors associatedwith reporting a history of non-fatal overdose are pre-sented in Table 1. As shown, the outcome was associatedat the p < 0.05 level with: reporting a history of incarcera-tion (Odds Ratio [OR] = 4.40, 95% Confidence Interval[CI]: 1.80 - 10.79); a history of using drugs in combinationhistory of using drugs in combination (yes vs. no); historyof methadone injection (yes vs. no); ever using an unster-ile syringe (yes vs. no); ever lending syringes (yes vs. no);(OR = 3.05, 95% CI: 1.53 - 6.07); and a history of injectingMidazolam (OR = 2.20, 95% CI: 1.67 - 4.12). A history ofinjecting heroin was significantly associated with report-Milloy et al. Harm Reduction Journal 2010, 7:9http://www.harmreductionjournal.com/content/7/1/9Page 3 of 7Table 1: Univariate analyses of factors associated with reporting a history of non-fatal overdose among IDU in MSHRC cohort (n = 252 individuals).Characteristic History of overdose n (%) OR1 95% CI2 p-valNo: 177 (70.2) Yes: 75 (29.8)AGEMedian (IQR) 37.0 (29.5 - 44.5) 35.0 (28.0 - 42.0) 0.99 0.97 - 1.03 0.843GENDERMale 130 (73.4) 56 (74.7)Female 47 (26.6) 19 (25.3) 0.93 0.51 - 1.74 0.877EDUCATION≥ Secondary 110 (62.1) 50 (66.7) 1.00< Secondary 37 (37.9) 25 (33.4) 0.82 0.47 - 1.45 0.568SEX TRADENo 167 (94.4) 71 (94.7) 1.00Yes 10 (5.6) 4 (5.3) 0.94 0.29 - 3.10 0.841EVER INJECT HEROINNo 18 (10.1) 0 (0.0)Yes 159 (89.9) 75 (100.0 0.002EVER INJECT YABANo 66 (37.3) 25 (33.3) 1.00Yes 111 (62.7) 50 (66.7) 1.19 0.67 - 2.10 0.570EVER INJECT MIDAZOLAMNo 66 (37.3) 16 (21.3) 1.00Yes 111 (62.7) 59 (78.7) 2.20 1.67 - 4.12 0.018EVER INJECT BENZODIAZEPINESNo 174 (98.3) 73 (97.3) 1.00Milloy et al. Harm Reduction Journal 2010, 7:9http://www.harmreductionjournal.com/content/7/1/9Page 4 of 7ing ever experiencing a non-fatal overdose (p = 0.002);however, as all individuals with a history of overdose alsoreported a history of heroin injection, an Odds Ratiocould not be calculated and that explanatory factor wasremoved from further consideration. The final multivari-ate model, presented in Table 2, included two factorsindependently associated with the outcome: Ever usingdrugs in combination (Adjusted Odds Ratio [AOR] =2.48, 95% CI: 1.16 - 5.33) and reporting a history of incar-ceration (AOR = 3.83, 95% CI: 1.52 - 9.65).Experience witnessing an overdose was reported by 171(67.9%) participants. When asked their response to theReduction Centre; 1 (0.6%) contacted the police. Twelveindividuals (7.0%) reported they did nothing in response.Approximately half of the participants reported theybelieved they had enough information to prevent (139,55.2%) and manage (128, 50.8%) an overdose. Whenasked how to manage an overdose, responses were: per-form first aid (115, 45.6%); inject salt water (109, 43.2%);perform CPR (90, 35.7%); slap (105, 41.7%); administernaloxone (16, 6.3%); or take to a hospital (74, 29.4%).DiscussionIn these analyses, we found a history of non-fatal over-Yes 3 (1.7) 2 (2.7) 1.59 0.26 - 9.71 0.636EVER INJECT METHADONENo 150 (84.7) 63 (84.0) 1.00Yes 27 (15.3) 12 (16.0) 1.06 0.50 - 2.22 0.851EVER USE DRUGS IN COMBINATIONNo 65 (36.7) 12 (16.0) 1.00Yes 112 (63.3) 63 (84.0) 3.05 1.53 - 6.07 < 0.001EVER INCARCERATEDNo 49 (27.7) 6 (8.0) 1.00Yes 128 (72.3) 69 (92.0) 4.40 1.80 - 10.79 < 0.001EVER ON MMTNo 102 (57.7) 39 (52.0) 1.00Yes 75 (42.3) 36 (48.0) 1.26 0.73 - 2.16 0.488EVER IN FORCED DRUG TREATMENTNo 127 (71.8) 45 (60.0) 1.00Yes 50 (28.2) 30 (40.0) 1.69 0.96 - 2.82 0.0761. Odds Ratio; 2. 95% Confidence IntervalTable 1: Univariate analyses of factors associated with reporting a history of non-fatal overdose among IDU in MSHRC cohort (n = 252 individuals). (Continued)last overdose witnessed, most (136, 79.5%) reported per-forming first aid; 78 (45.6%) took the overdose sufferer toa hospital; 4 (2.3%) took them to the Mit Sampan Harmdose was common among Thai IDU, with more than one-quarter of the sample (29.8%) reporting a previous over-dose event. The predominant drug implicated in over-Milloy et al. Harm Reduction Journal 2010, 7:9http://www.harmreductionjournal.com/content/7/1/9Page 5 of 7dose events was heroin, with the majority of individualsreporting injecting heroin before their last overdose andevery individual with a history of overdose also reportinga history of heroin use. In a multivariate model, a historyof overdose was linked to poly-drug use and incarcera-tion. Most of the participants also reported experiencewitnessing an overdose (67.9%) and the most commonresponses included performing first aid and taking thevictim to a hospital. When asked how to manage an over-dose, the most common responses included performingfirst aid or artificial respiration and injecting salt water.The level of non-fatal overdose observed in this sampleis on the lower end of the range of estimates calculated insimilar studies of community-based IDU in Baltimore,Maryland (24.7%) [21]; London, England (37.8%) [22] andSan Francisco, California (47.9%) [23]. We are unable todetermine if this comparatively lower level is the result ofa lower incidence of overdose among Thai IDU or agreater risk of death at each overdose event. Severalpoints of evidence support a contribution from the lattereffect, including the high prevalence of witnessing over-doses; the pervasive level of misperceptions concerninghow to manage an overdose; the high prevalence of over-dose as the reported cause of death among Thai IDU intwo HIV vaccine preparatory studies [24,25]; and theongoing violent crackdown by Thai police against drugusers, a phenomenon linked to a greater risk of overdosemortality in other settings [26-28].Our findings identify the need for enhanced educationfor Thai IDU to prevent and manage overdoses. Specifi-cally, approximately half of respondents indicated theydid not have the information required to prevent andmanage overdoses. This lack of knowledge was reflectedin the substantial proportion of participants reportinghours to develop [29,30], the need to improve peerresponses is clear. Inappropriate or suboptimal responsesby IDU to overdose are not uncommon and have beenreported from a number of settings [26,29,31]. However,overdose management education has been shown to beeffective at training IDU to respond appropriately tooverdose [26,32].These findings also support the distribution of nalox-one to drug users. Naloxone, an opiate antagonist, is thestandard treatment used by healthcare professionals inresuscitation efforts following opioid overdose. Programsto train IDU in overdose response alongside distributionof naloxone would likely benefit Thai IDU, given that opi-ates were the most common class of drugs reported bythis sample prior to their last overdose. Additionally,given pervasive anti-drug user stigma [33,34] and theongoing violent campaign by police [35], many IDU maybe unwilling to seek professional health care in the eventof an overdose. Evaluations of analagous interventions inChicago [36], New York City [10] and San Francisco [37]have observed positive impacts, including hundreds ofsuccessful peer opioid overdose resuscitations. Currently,naloxone is only available to IDU in Thailand at theMSHRC.In the multivariate model, a history of incarcerationwas independently associated with ever overdosing. Thisis in line with previous analyses that have identified ahigh risk of overdose, including fatal overdose, associatedwith incarceration, especially in the first weeks followingrelease from detention [38,39]. In the Thai context, previ-ous studies have described the links between exposure tocorrectional environments and an elevated risk of HIVinfection among IDU [40,41]. Our findings add evidencesupporting the need for an expansion of harm reductionTable 2: Multivariate logistic regression analysis of factors associated with reporting a history of non-fatal overdose in MSHRC cohort (n = 252 individuals).Characteristic AOR1 95% CI2 p-valueEver injected Midazolam (Yes vs. no)1.38 0.68 - 2.81 0.379Ever used in combination (Yes vs. no)2.48 1.16 - 5.33 0.020Ever incarcerated (Yes vs. no) 3.83 1.52 - 9.65 0.004Ever in forced treatment (Yes vs. no)1.25 0.69 - 2.28 0.4571. Adjusted Odds Ratio; 2. 95% Confidence Intervalinappropriate responses, including injecting the suffererwith salt water. Given that witnessing an overdose wascommon in this setting and fatal overdoses typically takeopportunities in Thai correctional settings, such as sub-stitution therapies, shown effective at reducing HIV riskMilloy et al. Harm Reduction Journal 2010, 7:9http://www.harmreductionjournal.com/content/7/1/9Page 6 of 7behaviours [42] and improving outcomes post-release[43].While the implementation of peer-based interventionsmight lower the incidence and severity of overdose eventsamong Thai IDU, our findings also have implications forother social- and structural-level policies. In particular,our findings are another example of how the reliance onenforcement-based strategies to respond to illicit druguse can produce further drug-related harms [44,45]. Justas some observers have identified deaths resulting fromthe Thai government's crackdown on drug users [35], ourfindings describe how criminal justice interventions canincrease the risks associated with overdose events. Weecho other authors who have credited the country's suc-cessful efforts to reduce the incidence of sexually-trans-mitted HIV infections to the government's adoption ofevidence-based policies [41,46] and urge a similar prag-matic initiative to replace dominant enforcement- andsuppression-based policies with harm reduction pro-grammes.Our study has limitations. First, cross-sectional analy-ses are unable to determine the temporal relationshipbetween outcome and exposure. Second, although ourmeasures are based on self-reports from IDU, we do notbelieve participants would have been more or less likelyto report a history of overdose based on the covariates weexamined. Finally, our sample of IDU was not recruited atrandom and thus may not necessarily generalize to othersamples of IDU in Thailand or other settings.ConclusionsWe observed that non-fatal overdose events were com-mon in this sample of Thai IDU. In a multivariate analy-sis, reporting a history of non-fatal overdose wasindependently associated with ever being incarceratedand ever using drugs in combination. A majority of par-ticipants reported witnessing overdoses as well as need-ing more information to respond appropriately. Ourfindings support the need to expand appropriate harmreduction strategies for drug users in Thailand, such aspeer-based overdose management including naloxonedistribution, and further highlight the need to balance thecurrent emphasis on enforcement-based responses toillicit drug use with health-focused interventions.Competing interestsThe authors declare that they have no competing interests.Authors' contributionsTK, EW, PS and KK conceived and designed the study; KK, PS, NF and KH imple-mented the study design, including data acquisition; M-JM performed the sta-tistical analysis, wrote the manuscript and coordinated all revisions; all authorsrevised the manuscript and read and approved the final draft.Social Pharmacy Research Unit (SPR), Faculty of Pharmaceutical Sciences, Chu-lalongkorn University, for her assistance with developing this project. We also thank Deborah Graham and Calvin Lai for their assistance with data manage-ment; Prempreeda Pramoj Na Ayutthaya and Donlachai Hawangchu for their assistance with data collection. This work was funded by the Canadian Insti-tutes of Health Research (Grant RAA-79918).Author Details1School of Population and Public Health, University of British Columbia, 5804 Fairview Avenue, Vancouver, British Columbia, V6T 1C3, Canada, 2British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 667-1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada, 3Thai AIDS Treatment Action Group, 18/89 Vipawadee Road, soi 40, Chatuchak, Bangkok, Thailand and 4Department of Medicine, University of British Columbia, Room 10203, 2775 Laurel Street, Vancouver, British Columbia, V5Z 1M9, CanadaReferences1. Bargagli AM, Hickman M, Davoli M, Perucci CA, Schifano P, Buster M, Brugal T, Vicente J, Group CE: Drug-related mortality and its impact on adult mortality in eight European countries.  European journal of public health 2006, 16:198-202.2. Centers for Disease Control: Unintentional poisoning deaths--United States, 1999-2004.  MMWR Morb Mortal Wkly Rep 2007, 56:93-96.3. Darke S, Hall W: Heroin overdose: research and evidence-based intervention.  J Urban Health 2003, 80:189-200.4. Darke S, Williamson A, Ross J, Mills KL, Havard A, Teesson M: Patterns of nonfatal heroin overdose over a 3-year period: findings from the Australian treatment outcome study.  Journal of urban health: bulletin of the New York Academy of Medicine 2007, 84:283-291.5. Kerr T, Fairbairn N, Tyndall M, Marsh D, Li K, Montaner J, Wood E: Predictors of non-fatal overdose among a cohort of polysubstance-using injection drug users.  Drug Alcohol Depend 2007, 87:39-45.6. Ochoa KC, Davidson PJ, Evans JL, Hahn JA, Page-Shafer K, Moss AR: Heroin overdose among young injection drug users in San Francisco.  Drug Alcohol Depend 2005, 80:297-302.7. Darke S, Williamson A, Ross J, Teesson M: Non-fatal heroin overdose, treatment exposure and client characteristics: findings from the Australian treatment outcome study (ATOS).  Drug Alcohol Rev 2005, 24:425-432.8. van Ameijden EJ, Langendam MW, Coutinho RA: Dose-effect relationship between overdose mortality and prescribed methadone dosage in low-threshold maintenance programs.  Addict Behav 1999, 24:559-563.9. Milloy MJ, Kerr T, Tyndall M, Montaner J, Wood E: Estimated drug overdose deaths averted by North America's first medically-supervised safer injection facility.  PLoS ONE 2008, 3:e3351.10. Piper TM, Stancliff S, Rudenstine S, Sherman S, Nandi V, Clear A, Galea S: Evaluation of a naloxone distribution and administration program in New York City.  Subst Use Misuse 2008, 43:858-870.11. Aceijas C, Friedman SR, Cooper HL, Wiessing L, Stimson GV, Hickman M: Estimates of injecting drug users at the national and local level in developing and transitional countries, and gender and age distribution.  Sexually transmitted infections 2006, 82(Suppl 3):iii10-17.12. Aceijas C, Stimson GV, Hickman M, Rhodes T, United Nations Reference Group on HIV/AIDS Prevention and Care among IDU in Developing and Transitional Countries: Global overview of injecting drug use and HIV infection among injecting drug users.  AIDS 2004, 18:2295-2303.13. Bergenstrom A, Quan VM, Van Nam L, McClausland K, Thuoc NP, Celentano D, Go V: A cross-sectional study on prevalence of non-fatal drug overdose and associated risk characteristics among out-of-treatment injecting drug users in North Vietnam.  Subst Use Misuse 2008, 43:73-84.14. Yin L, Qin G, Ruan Y, Qian H, Hao C, Xie L, Chen K, Zhang Y, Xia Y, Wu J, et al.: Nonfatal overdose among heroin users in southwestern China.  The Received: 26 October 2009 Accepted: 13 May 2010 Published: 13 May 2010This article is available from: http://www.harmreductionjournal.com/content/7/1/9© 2010 Milloy et al; licensee BioMed Centr l Ltd. is an Open Access article distribut d unde  the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Harm Reduction Journal 2010, 7:9AcknowledgementsWe would like to thank the staff and volunteers at the Mitsampan Harm Reduc-tion Center for their support. We also thank Dr. Niyada Kiatying-Angsulee of the American journal of drug and alcohol abuse 2007, 33:505-516.15. Beyrer C, Jittiwutikarn J, Teokul W, Razak MH, Suriyanon V, Srirak N, Vongchuk T, Tovanabutra S, Sripaipan T, Celentano DD: Drug use, Milloy et al. Harm Reduction Journal 2010, 7:9http://www.harmreductionjournal.com/content/7/1/9Page 7 of 7increasing incarceration rates, and prison-associated HIV risks in Thailand.  AIDS and behavior 2003, 7:153-161.16. Kerr T, Kaplan K, Suwannawong P, Wood E: Health and human rights in the midst of a drug war: the Thai Drug Users' Network.  In Public health and human rights: Evidence-based approaches Edited by: Beyrer C, Pizer H. Baltimore, Maryland, United States: Johns Hopkins; 2007. 17. Celentano DD, Hodge MJ, Razak MH, Beyrer C, Kawichai S, Cegielski JP, Nelson KE, Jittiwutikarn J: HIV-1 incidence among opiate users in northern Thailand.  Am J Epidemiol 1999, 149:558-564.18. Latkin CA, Donnell D, Metzger D, Sherman S, Aramrattna A, Davis-Vogel A, Quan VM, Gandham S, Vongchak T, Perdue T, Celentano DD: The efficacy of a network intervention to reduce HIV risk behaviors among drug users and risk partners in Chiang Mai, Thailand and Philadelphia, USA.  Soc Sci Med 2008:740-748.19. Jittiwutikarn J, Thongsawat S, Suriyanon V, Maneekarn N, Celentano D, Razak MH, Srirak N, Vongchak T, Kawichai S, Thomas D, et al.: Hepatitis C infection among drug users in northern Thailand.  Am J Trop Med Hyg 2006, 74:1111-1116.20. Celentano DD, Sirirojn B, Sutcliffe CG, Quan VM, Thomson N, Keawvichit R, Wongworapat K, Latkin C, Taechareonkul S, Sherman SG, Aramrattana A: Sexually transmitted infections and sexual and substance use correlates among young adults in Chiang Mai, Thailand.  Sex Transm Dis 2008, 35:400-405.21. Latkin CA, Hua W, Tobin K: Social network correlates of self-reported non-fatal overdose.  Drug Alcohol Depend 2004, 73:61-67.22. Strang J, Powis B, Best D, Vingoe L, Griffiths P, Taylor C, Welch S, Gossop M: Preventing opiate overdose fatalities with take-home naloxone: pre-launch study of possible impact and acceptability.  Addiction 1999, 94:199-204.23. Seal KH, Kral AH, Gee L, Moore LD, Bluthenthal RN, Lorvick J, Edlin BR: Predictors and prevention of nonfatal overdose among street-recruited injection heroin users in the San Francisco Bay Area, 1998-1999.  Am J Public Health 2001, 91:1842-1846.24. Vanichseni S, Kitayaporn D, Mastro TD, Mock PA, Raktham S, Des Jarlais DC, Sujarita S, Srisuwanvilai LO, Young NL, Wasi C, et al.: Continued high HIV-1 incidence in a vaccine trial preparatory cohort of injection drug users in Bangkok, Thailand.  AIDS 2001, 15:397-405.25. Pitisuttithum P, Gilbert P, Gurwith M, Heyward W, Martin M, van Griensven F, Hu D, Tappero JW, Choopanya K: Randomized, double-blind, placebo-controlled efficacy trial of a bivalent recombinant glycoprotein 120 HIV-1 vaccine among injection drug users in Bangkok, Thailand.  J Infect Dis 2006, 194:1661-1671.26. Pollini RA, McCall L, Mehta SH, Celentano DD, Vlahov D, Strathdee SA: Response to overdose among injection drug users.  Am J Prev Med 2006, 31:261-264.27. Tracy M, Piper TM, Ompad D, Bucciarelli A, Coffin PO, Vlahov D, Galea S: Circumstances of witnessed drug overdose in New York City: implications for intervention.  Drug Alcohol Depend 2005, 79:181-190.28. Seal KH, Downing M, Kral AH, Singleton-Banks S, Hammond JP, Lorvick J, Ciccarone D, Edlin BR: Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area.  J Urban Health 2003, 80:291-301.29. Davidson PJ, McLean RL, Kral AH, Gleghorn AA, Edlin BR, Moss AR: Fatal heroin-related overdose in San Francisco, 1997-2000: a case for targeted intervention.  J Urban Health 2003, 80:261-273.30. Zador D, Sunjic S, Darke S: Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances.  Med J Aust 1996, 164:204-207.31. Davidson PJ, Ochoa KC, Hahn JA, Evans JL, Moss AR: Witnessing heroin-related overdoses: the experiences of young injectors in San Francisco.  Addiction 2002, 97:1511-1516.32. Green TC, Heimer R, Grau LE: Distinguishing signs of opioid overdose and indication for naloxone: an evaluation of six overdose training and naloxone distribution programs in the United States.  Addiction 2008, 103:979-989.33. Chan KY, Stoove MA, Sringernyuang L, Reidpath DD: Stigmatization of AIDS patients: disentangling Thai nursing students' attitudes towards 35. Human Rights Watch: Not enough graves: The war on drugs, HIV/AIDS, and violations of human rights.  New York City, New York, United States: Human Rights Watch; 2004. 36. Maxwell S, Bigg D, Stanczykiewicz K, Carlberg-Racich S: Prescribing naloxone to actively injecting heroin users: a program to reduce heroin overdose deaths.  J Addict Dis 2006, 25:89-96.37. Seal KH, Thawley R, Gee L, Bamberger J, Kral AH, Ciccarone D, Downing M, Edlin BR: Naloxone distribution and cardiopulmonary resuscitation training for injection drug users to prevent heroin overdose death: a pilot intervention study.  J Urban Health 2005, 82:303-311.38. Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD: Release from prison--a high risk of death for former inmates.  N Engl J Med 2007, 356:157-165.39. Farrell M, Marsden J: Acute risk of drug-related death among newly released prisoners in England and Wales.  Addiction 2008, 103:251-255.40. Buavirat A, Page-Shafer K, van Griensven GJ, Mandel JS, Evans J, Chuaratanaphong J, Chiamwongpat S, Sacks R, Moss A: Risk of prevalent HIV infection associated with incarceration among injecting drug users in Bangkok, Thailand: case-control study.  BMJ 2003, 326:308.41. Beyrer C, Jittiwutikarn J, Teokul W, Razak MH, Suriyanon V, Srirak N, Vongchuk T, Tovanabutra S, Sripaipan T, Celentano DD: Drug use, increasing incarceration rates, and prison-associated HIV risks in Thailand.  AIDS Behav 2003, 7:153-161.42. Sorensen JL, Copeland AL: Drug abuse treatment as an HIV prevention strategy: a review.  Drug Alcohol Depend 2000, 59:17-31.43. Gordon MS, Kinlock TW, Schwartz RP, O'Grady KE: A randomized clinical trial of methadone maintenance for prisoners: findings at 6 months post-release.  Addiction 2008, 103:1333-1342.44. Kerr T, Small W, Wood E: The public health and social impacts of drug market enforcement: A review of the evidence.  Int J Drug Policy 2005, 16:210-220.45. Maher L, Dixon D: Policing and public health: Law enforcement and harm minimization in a street-level drug market.  British Journal of Criminology 1999, 39:488-512.46. Celentano DD: HIV prevention among drug users: an international perspective from Thailand.  J Urban Health 2003, 80:iii97-105.doi: 10.1186/1477-7517-7-9Cite this article as: Milloy et al., Overdose experiences among injection drug users in Bangkok, Thailand Harm Reduction Journal 2010, 7:9HIV/AIDS, drug use, and commercial sex.  AIDS Behav 2008, 12:146-157.34. Simmonds L, Coomber R: Injecting drug users: A stigmatised and stigmatising population.  Int J Drug Policy 2007:121-130.

Cite

Citation Scheme:

        

Citations by CSL (citeproc-js)

Usage Statistics

Share

Embed

Customize your widget with the following options, then copy and paste the code below into the HTML of your page to embed this item in your website.
                        
                            <div id="ubcOpenCollectionsWidgetDisplay">
                            <script id="ubcOpenCollectionsWidget"
                            src="{[{embed.src}]}"
                            data-item="{[{embed.item}]}"
                            data-collection="{[{embed.collection}]}"
                            data-metadata="{[{embed.showMetadata}]}"
                            data-width="{[{embed.width}]}"
                            async >
                            </script>
                            </div>
                        
                    
IIIF logo Our image viewer uses the IIIF 2.0 standard. To load this item in other compatible viewers, use this url:
http://iiif.library.ubc.ca/presentation/dsp.52383.1-0223549/manifest

Comment

Related Items