AI Article Synopsis
- Incarceration linked to drug issues negatively impacts people who inject drugs (PWID), prompting the Proyecto Escudo initiative in Tijuana, Mexico, which trained over 1,800 police officers on harm reduction and decriminalization efforts.
- A study assessed the effects of this initiative, showing a 21% decline in recent incarceration rates among PWID in the two years following the training, leading to significant reductions in new HIV cases and fatal overdoses.
- The intervention proved cost-effective, with a cost per disability-adjusted life year (DALY) averted lower than traditional willingness-to-pay thresholds, suggesting that similar programs could have positive public health impacts.
Article Abstract
Background: Incarceration is associated with drug-related harms among people who inject drugs (PWID). We trained >1800 police officers in Tijuana, Mexico on occupational safety and HIV/HCV, harm reduction, and decriminalization reforms (Proyecto Escudo). We evaluated its effect on incarceration, population impact and cost-effectiveness on HIV and fatal overdose among PWID.
Methods: We assessed self-reported recent incarceration in a longitudinal cohort of PWID before and after Escudo. Segmented regression was used to compare linear trends in log risk of incarceration among PWID pre-Escudo (2012-2015) and post-Escudo (2016-2018). We estimated population impact using a dynamic model of HIV transmission and fatal overdose among PWID, with incarceration associated with syringe sharing and fatal overdose. The model was calibrated to HIV and incarceration patterns in Tijuana. We compared a scenario with Escudo (observed incarceration declines for 2 years post-Escudo among PWID from the segmented regression) compared to a counterfactual of no Escudo (continuation of stable pre-Escudo trends), assessing cost-effectiveness from a societal perspective. Using a 2-year intervention effect and 50-year time horizon, we determined the incremental cost-effectiveness ratio (ICER, in 2022 USD per disability-adjusted life years [DALYs] averted).
Findings: Compared to stable incarceration pre-Escudo, for every three-month interval in the post-Escudo period, recent incarceration among PWID declined by 21% (adjusted relative risk = 0.79, 95% CI: 0.68-0.91). Based on these declines, we estimated 1.7% [95% interval: 0.7%-3.5%] of new HIV cases and 12.2% [4.5%-26.6%] of fatal overdoses among PWID were averted in the 2 years post-Escudo, compared to a counterfactual without Escudo. Escudo was cost-effective (ICER USD 3746/DALY averted compared to a willingness-to-pay threshold of $4842-$13,557).
Interpretation: Escudo is a cost-effective structural intervention that aligned policing practices and human-rights-based public health practices, which could serve as a model for other settings where policing constitutes structural HIV and overdose risk among PWID.
Funding: National Institute on Drug Abuse, UC MEXUS CONACyT, and the San Diego Center for AIDS Research (SD CFAR).
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10847144 | PMC |
| http://dx.doi.org/10.1016/j.lana.2024.100679 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Individual and prescription level factors associated with overdose in opioid naïve older people.
J Am Geriatr Soc
December 2024
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Background: Opioid naïve older adults may be at risk of overdose after receiving an initial opioid prescription.
Methods: This population-based cohort study from a linked dataset of patients in Oregon, linking all payer claims data to other administrative datasets, aimed to assess the prescription- and patient-level characteristics associated with increased odds of opioid overdose after an initial opioid prescription. Included patients were ≥65 years old and received an index pain-formulation opioid prescription between 2016 and 2019.
Advanced strategies for intensive care management of acute liver failure.
Best Pract Res Clin Gastroenterol
December 2024
Department of Anesthesiology and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA.
Acute liver failure (ALF) is defined as the loss of hepatic function in conjunction with hepatic encephalopathy and coagulopathy. There is histological evidence of profound hepatocyte damage. If it is not aggressively managed, ALF can be fatal within a few days.
View Article and Find Full Text PDFDeep ultraviolet Raman spectroscopic analysis of antihistamine drugs in oral fluid for forensic purposes.
Spectrochim Acta A Mol Biomol Spectrosc
December 2024
Department of Chemistry, University at Albany, SUNY, 1400 Washington Avenue, Albany, NY 12222, USA. Electronic address:
Owing to its inherent nondestructive nature, rapid analysis and simplicity, Raman spectroscopy has emerged as a promising tool for forensic analysis of different bodily fluids, particularly oral fluid (OF). Accurate drug identification and quantification are essential for understanding the circumstances surrounding a case, such as whether it involves an overdose fatality, substance abuse, or drug trafficking. This study aims to evaluate the potential of using deep ultraviolet Raman spectroscopy (DUVRS) to detect the antihistamine cetirizine (CTZ) in liquid and solid OF samples.
View Article and Find Full Text PDFWho feels safe calling 911: are prior experiences of anti-Black racial discrimination associated with hesitancy seeking emergency medical services in the event of accidental drug overdose? - a study protocol.
Ann Med
December 2025
Department of Psychiatry, New York University Grossman School of Medicine, New York, New York, USA.
Background: Racial discrimination is associated with health disparities among Black Americans, a group that has experienced an increase in rates of fatal drug overdose. Prior research has found that racial discrimination in the medical setting may be a barrier to addiction treatment. Nevertheless, it is unknown how experiences of racial discrimination might impact engagement with emergency medical services for accidental drug overdose.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!