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The Republic and HBO's The Wire PHIL-255-01: Drugs in Baltimore

Drug Overview

Genberg, Becky L., et al. "Incarceration and injection drug use in Baltimore, Maryland." Addiction 110, no. 7 (July 2015): 1152-1159. Academic Search Ultimate, EBSCOhost (accessed September 29, 2017).

Aims There is limited longitudinal research examining incarceration and subsequent changes in drug use among people who inject drugs (PWID) in the United States. The objective of the current study was to characterize the frequency of incarceration and estimate the association between incarceration and subsequent injection drug use among current and former PWIDs in one US city. Design ALIVE (AIDS Linked to the Intravenous Experience) is a prospective cohort study of current and former PWIDs, with semi-annual follow-up occurring since 1988. Setting Baltimore, Maryland, USA. Participants A total of 3245 participants with 48 738 study visits were included. Participants enrolled from 1988 to 2012 with a median of 13 follow-up visits per participant (Interquartile range = 7-25). Measurements Incarcerations were defined as any self-reported jail or prison stays in the previous 6 months that were ≥7 days or longer. The primary outcome was defined as any self-reported injection drug use in the previous 6 months. Findings At baseline, 29% were female, 90% African American and 33% HIV-positive. Fifty-seven per cent of participants experienced at least one incarceration episode. After adjusting for confounders, there was a positive association between incarceration and subsequent injection drug use [adjusted odds ratio (AOR) = 1.48, 95% confidence interval (CI) = 1.37-1.59]; however, stratified analysis showed that the effect was restricted to those who were not injecting at the time of incarceration (AOR = 2.11, 95% CI = 1.88-2.37). Conclusions In the United States, incarceration of people who had previously stopped injecting drugs appears to be associated with an increased risk of subsequent injecting.


Newspaper article:

Stern, Nick. 2017. "As Opioid Crisis Spreads, Treatments Remain Underutilized ."  Daily Record, The (Baltimore, MD),  Aug.29.,270077,11059,8411&hl=t&hv=t&hnsd=f&hns=t&hgn=t&oc=00240&perma=true.

Duncan, Ian. 2017. "When Bullets Kill Someone in Baltimore, the Public Knows Right Away. when Drugs do, Notice Takes Months." TCA Regional News, Sep 21.

Drugs and Depression

Yang, Jingyan, et al. "Bidirectional Influence: A Longitudinal Analysis of Size of Drug Network and Depression Among Inner-City Residents in Baltimore, Maryland." Substance Use & Misuse 50, no. 12 (October 2015): 1544-1551. Academic Search Ultimate, EBSCOhost (accessed September 29, 2017).
Background:The prevalence of depression among drug users is high. It has been recognized that drug use behaviors can be influenced and spread through social networks.Objectives:We investigated the directional relationship between social network factors and depressive symptoms among a sample of inner-city residents in Baltimore, MD.Methods:We performed a longitudinal study of four-wave data collected from a network-based HIV/STI prevention intervention for women and network members, consisting of both men and women. Our primary outcome and exposure were depression using CESD scale and social network characteristics, respectively. Linear-mixed model with clustering adjustment was used to account for both repeated measurement and network design.Results:Of the 746 participants, those who had high levels of depression tended to be female, less educated, homeless, smokers, and did not have a main partner. In the univariate longitudinal model, larger size of drug network was significantly associated with depression (OR = 1.38,p< .001). This relationship held after controlling for age, gender, homeless in the past 6 months, college education, having a main partner, cigarette smoking, perceived health, and social support network (aOR = 1.19,p= .001). In the univariate mixed model using depression to predict size of drug network, the data suggested that depression was associated with larger size of drug network (coef. = 1.23,p< .001) and the same relation held in multivariate model (adjusted coef. = 1.08,p= .001).Conclusions:The results suggest that larger size of drug network is a risk factor for depression, and vice versa. Further intervention strategies to reduce depression should address social networks factors.

Drugs and Law Enforcement

Beletsky, Leo, Jess Cochrane, Anne L. Sawyer, Chris Serio-Chapman, Marina Smelyanskaya, Jennifer Han, Natanya Robinowitz, and Susan G. Sherman. 2015. "Police Encounters Among Needle Exchange Clients in Baltimore: Drug Law Enforcement as a Structural Determinant of Health." American Journal Of Public Health 105, no. 9: 1872-1879. Academic Search Ultimate, EBSCOhost (accessed September 29, 2017).

Objectives. We piloted a monitoring mechanism to document police encounters around programs targeting people who inject drugs (PWID), and assessed their demographic predictors at 2 Baltimore, Maryland, needle exchange program (NEP) sites. Methods. In a brief survey, 308 clients quantified, characterized, and sited recent police encounters. Multivariate linear regression determined encounter predictors, and we used geocoordinate maps to illustrate clusters. Results. Within the past 6 months, clients reported a median of 3 stops near NEP sites (interquartile range [IQR] = 0-7.5) and a median of 1 arrest in any location (IQR = 0-2). Three respondents reported police referral to the NEP. Being younger (P= .009), being male (P= .033), and making frequent NEP visits (P= .02) were associated with reported police stops. Among clients reporting arrest or citation for syringe possession, Whites were significantly less likely than non-Whites to report being en route to or from an NEP (P<.001). Reported encounters were clustered around NEPs. Conclusions. Systematic surveillance of structural determinants of health for PWID proved feasible when integrated into service activities. Improved monitoring is critical to informing interventions to align policing with public health, especially among groups subject to disproportionate levels of drug law enforcement. [ABSTRACT FROM AUTHOR]