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Psychiatrists, psychiatric residents, non psychiatric physicians, psychologists, philosophers or other health professionals or persons interested in this area can take part in the journal. This journal publishes original works, revision or updating articles, case reports of all psychiatry and mental health areas, epistemology, mind philosophy, bioethics and also articles about methodology of research and critical reading. SRJ is a prestige metric based on the idea that not all citations are the same. SJR uses a similar algorithm as the Google page rank; it provides a quantitative and qualitative measure of the journal's impact. SNIP measures contextual citation impact by wighting citations based on the total number of citations in a subject field. Colombia is facing a rising epidemic of intravenous heroin use. Knowledge of the methadone-assisted treatment programmes in the country is crucial in order to propose improvement strategies.. The demographic and clinical characteristics of the patients attending the programmes, a description of the services offered, their methadone treatment protocols, the various barriers to treatment and the causes of treatment abandonment were reviewed.. Most of the patients attending these programmes were men Psychiatric comorbidity was more likely in patients attending the private sector The initial average dose of methadone administered was The treatment protocols of these programmes offer different levels of development and implementation. Some of the barriers to access and reasons for abandonment of treatment with methadone can be mitigated with better health administration.. Se encuestaron 13 programas de regiones prioritarias. Heroin use in the Colombian population had a lifetime prevalence of 0. These programmes have been using methadone in tablet form only, as liquid methadone is not available in Colombia. The use of liquid methadone with digital administration systems facilitates the safe dosing and monitoring of the drug during treatment in countries where it is available. An additional objective of this study was to describe the significant differences between public and private programmes. These include non-profit organisations and non-governmental organisations NGOs. It is hoped that this more detailed knowledge of users, programmes and barriers to treatment might help us to identify areas that require improvement and increase our ability to put forward strategies to mitigate the impact on health. All programmes in these locations that had reported MAT for opioid use disorder were selected. The assessment instrument was designed based on the questionnaire used to characterise the services available in the United States, 14 which was adjusted based on a literature review 15—17 and adapted to the country's needs with feedback from experts with knowledge of treatment centres in Colombia. The instrument comprises five sections assessing: a user characteristics; b programme characteristics; c severity of barriers to access and causes of treatment abandonment; d treatment models and medications used; and e specific details of the MAT protocols used by each programme. The instrument was consensually reviewed by three national experts, then emailed to the 13 different programmes providing MAT for opioid use disorder heroin and opiate addiction. Differences in the amplitude of barriers to access and causes of treatment abandonment were analysed using a scale from 0 never occurs to 5 always present , using ANOVA and post hoc analysis to assess the differences between each barrier or reason. Statistical significance was defined using two-tailed alpha tests and p value Twelve questionnaires were received out of the thirteen sent to the selected facilities in the seven regions and cities prioritised. Table 1 shows the aggregated characteristics of the programmes, with descriptions of the patients on active treatment and the services provided by the programmes, as well as the relevant differences between public and private facilities. Methadone-assisted treatment programmes in Colombia. Affiliated: with national resources for the uninsured low-income population; Contributory: with direct payment by workers; EPS: health promotion company; Subsidised: with funding from the state and other supportive sources. The total number of patients on active MAT was Some Psychiatric comorbidity is significantly more associated with patients with opiate addiction who use private sector services The treatment programmes are mostly of medium complexity. As was anticipated, private facilities obtain Regarding funding sources, The treatment programmes generally have multidisciplinary treatment teams. All have a psychologist and psychiatrist; Only two Only one of the treatment programmes 8. As matters currently stand, the treatment centres have not yet implemented harm reduction strategies such as providing syringes or rooms for clean drug use for people who cannot achieve or are not interested in achieving total abstinence. Most of the programmes offer psychotherapy interventions with various orientations, but almost never use step therapy. Two programmes are educating patients and their relatives about first-aid manoeuvres for opiate overdose. The total number of patients on active MAT was with a mean of As can be seen in Table 2 , the average initial dose during outpatient methadone induction was This initial dose of methadone was increased by an average of 7. Two of the programmes reported that, per protocol, they always induced methadone treatment with the patient hospitalised, before continuing it on an outpatient basis. The average number of days required before the patient is able to take methadone at home without supervision by medical staff is Finally, the programmes perform an average of one toxicology test every three weeks range 1—8. Methadone-assisted treatment protocols. Colombia, The results of the post hoc analysis reveal that lack of coordination with primary care is significantly the greatest obstacle to accessing MAT, with a mean of 3. Although the lack of clarity regarding the route of access 2. In addition, Barriers to accessing treatment with methadone. The results of the post hoc analysis suggest that lack of methadone supply is a significantly more common cause of treatment abandonment, with a mean of 2. In contrast, travel costs or distance from home 2. The results of differences between public and private programmes for barriers to treatment and treatment abandonment are not presented as they were not significant. Reasons for which people on methadone treatment abandon it. This study's findings suggest that in general the Colombian MAT programmes analysed have unequal development and implementation of national and international protocols. Among the twelve programmes assessed, some are in the early phases of this implementation, while others are much more developed. For example, one programme reported new patients with opioid addiction in the last year, but only had five patients on MAT. This administrative decision is a consequence of the restrictions of EPSs, which in this case only cover treatments for overcoming the addiction, not mitigation. Some of the programmes studied preferred to start induction of methadone treatment with the patient hospitalised, before continuing it on an outpatient basis. The internationally accepted standard is that hospitalisation is not necessary when inducing methadone treatment. Centres specialising in MAT must also offer harm reduction programmes including needle exchange programmes 30,31 or rooms for clean drug use to encourage people who are not yet interested in stopping using heroin to make use of treatment centres. If they are to do this, they must be capable of identifying the people exposed to this risk, warning them of the inherent risk of interaction of these substances with methadone, performing alcohol breathalyser tests and developing protocols to temporarily reduce the methadone dose based on alcohol consumption or the use of benzodiazepines. Equally, as not all programmes have the capacity for patients to receive methadone daily at the treatment centre, which is the ideal and the safest option, other alternative means of supplying medication need to be sought. Currently, methadone tablets are dispensed for long treatment periods, which risks them ending up on the black market, patients failing to return to treatment centres and a consequent drop in psychosocial interventions. One practical solution implemented in some Colombian programmes, which, although not optimal, does offer a degree of safety, is the involvement of an advisor who keeps the methadone and only administers the daily dose indicated by the physician. Another potential alternative to this dilemma is to supply methadone daily from a mobile vehicle that travels around the city and also enables people with transport difficulties to access treatment. The reason for this finding is not clear, but one possible explanation for this significant difference may be an increase in the prevalence of opiate use at these ages among the people who access this sector or, conversely, a barrier to people in these age groups and situations accessing treatment in the public sector as another alternative. With regard to barriers to accessing treatment, lack of coordination with primary care is considered to be the most significantly problematic barrier. Currently, just one treatment programme participating in MAT is effectively coordinating with primary care. Training primary care teams to screen, identify and refer patients with heroin addiction could be one of the actions best able to improve this coordination. Specialist centres will need to provide guidance on referrals, training and consultancy. With time, primary care teams will have the experience to treat stable, low-complexity patients. This is an opportunity for developing and strengthening ties that can be implemented to facilitate access to services and make supervised doses the rule rather than the exception. The second most noted barrier to accessing treatment is the lack of clarity regarding how to access it. Most prevalently, this takes the form of service orders rejected or denied by the EPS, followed by lack of clarity for users regarding coverage of the service. These are some of the most common reasons for patients abandoning treatment. There is therefore a need to train both administrative and clinical staff in the basics of MAT so that the former are not an obstacle and the latter administer it appropriately and correctly according to the highest internationally recognised standards. Three of the barriers to accessing treatment identified—lack of knowledge of the existence of methadone treatment services among the population, community prejudices and those of the medical profession—can be changed through a sustained information and education campaign. Likewise, increased education on the problems associated with the use of psychoactive substances and their pharmacological treatments in the schools that train healthcare professionals could increase knowledge and reduce prejudice towards medication-assisted treatments for addiction problems. Finally, together with the administrative and insurance problems described above, the lack of availability of methadone in the country is a significant cause of treatment abandonment that must be prevented. Users in Colombia frequently see their 40 mg tablets changed to 10 mg tablets and vice versa depending on availability. This means the price of the medication varies constantly and leads to dissatisfaction among users because the 10 mg tablets are more expensive. The health authority is obliged to guarantee the permanent availability of any medication used in the treatment of chronic diseases, as is the case, in order to improve adherence to treatment, prevent abandonment and improve recovery rates. Liquid methadone, together with daily dispensing using a digital pump system, can increase safe administration during outpatient induction, reduce diversions to the black market and facilitate medication withdrawal when this is indicated. Moreover, importing other medications such as buprenorphine and naltrexone should be considered as a means to increase access to treatment for opiate addiction. In order to resolve the issue of the national availability of methadone, an increase in Colombia's permitted methadone quota will need to be negotiated by the country's representative on the United Nations Commission on Narcotic Drugs. Given that this is an emerging cross-sectoral public health issue in Colombia, the national authorities—such as the Ministry of Health, the Treasury, the Ministry of Education and the National Narcotics Fund—must guarantee sufficient appropriations to meet the demand for prevention, mitigation and overcoming the addiction that this issue entails. It is essential that the national authorities guarantee methadone acquisition that meets demand, in order to guarantee continuity of treatment. The Colombian state has made enormous efforts to confront heroin addiction from a harm reduction standpoint. This experience is useful and has its strengths and weaknesses, having contributed to stemming not only the financial costs, but more particularly the personal and community costs of pain and decline. The increase in the use of heroin in some regions and cities in Colombia is concerning due to the evidence of intravenous use, with the practice of sharing paraphernalia, and an increase in the prevalence of HIV and hepatitis C infections. Data on treatment services highlight the rapid adaptation of existing programmes in mental health and drug addiction to incorporate the use of MAT, which are at different stages of development from the protocols implemented to date. The lack of infrastructure and experience in starting MAT appears to have driven a need for hospitalisation, which will surely change with improvements to the conditions in which MAT is administered. The barriers to access and retention problems identified can be easily mitigated through better health administration, including the Colombian authorities guaranteeing the continuous availability of methadone for the treatment of opiate addiction. The Colombian experience confronting intravenous heroin use as an emerging disease with a recognised public health impact may serve as a guide for other South American states with higher levels of use. The authors declare that no experiments were performed on humans or animals for this research. The authors declare that no patient data appear in this article. UNODC contract no. The authors have no conflicts of interest to declare. We would also like to thank the directors and delegates of the participating facilities who responded to the questionnaires and took part in discussion round tables.. Rev Colomb Psiquiat. ISSN: Previous article Next article. Issue 2. Pages April - June More article options. Original article. DOI: Facing the growing heroin problem in Colombia: The new methadone-assisted treatment programmes. Download PDF. Corresponding author. This item has received. Article information. Table 1. Methadone-assisted treatment programmes in Colombia.. Table 2. Show more Show less. Objective Colombia is facing a rising epidemic of intravenous heroin use. Knowledge of the methadone-assisted treatment programmes in the country is crucial in order to propose improvement strategies. Methods 13 programmes from priority regions were surveyed. The demographic and clinical characteristics of the patients attending the programmes, a description of the services offered, their methadone treatment protocols, the various barriers to treatment and the causes of treatment abandonment were reviewed. Conclusions The treatment protocols of these programmes offer different levels of development and implementation. Some of the barriers to access and reasons for abandonment of treatment with methadone can be mitigated with better health administration. Methadone-assisted treatment. Palabras clave:. Tratamiento asistido con metadona. Full Text. Introduction Heroin use in the Colombian population had a lifetime prevalence of 0. Statistical significance was defined using two-tailed alpha tests and p value Results Twelve questionnaires were received out of the thirteen sent to the selected facilities in the seven regions and cities prioritised. We would also like to thank the directors and delegates of the participating facilities who responded to the questionnaires and took part in discussion round tables. Ministerio de la Proteccion Social, ,. Gomez-Restrepo, C. Escudero de Santacruz, D. Matallana, L. Gonzalez, V. Report of the International Narcotics Control Board for United Nations Publications, ,. Zapata, L. Methadone substitution treatment for heroin addiction: a program assessment in Colombia. Adicciones, 24 , pp. Respondent-driven sampling: a new approach to the study of hidden populations. Soc Prob, 44 , pp. Castano Perez, G. Calderon Vallejo. Patterns of heroin use in a sample of consumers in Medellin — Colombia. Rev Bras Epidemiol, 15 , pp. Berbesi Fernandez, L. Montoya Velez, A. Segura Cardona, P. Mateu-Gelabert, S. Harris, D. Berbesi, A. Segura Cardona, L. Montoya Velez, I. Mejia Motta, et al. Subst Use Misuse, 51 , pp. Resolucion No. Lawrinson, R. Ali, A. Buavirat, S. Chiamwongpaet, S. Dvoryak, B. Habrat, et al. Addiction, , pp. Gowing, M. Hickman, L. Mitigating the risk of HIV infection with opioid substitution treatment. Bull WHO, 91 , pp. Kermode, N. Crofts, M. Kumar, J. Opioid substitution therapy in resource-poor settings. Bull WHO, 89 , pp. Giraldo Ferrer, J. Delgado Velez, C. Herrera Cossio, A. Ulloa Vergara, J. Lopez Lara, A. Suarez Bermudez, et al. Guidelines for the psychosocially assisted pharmacological treatment of opioid dependence. WHO Press, ,. Black, K. Trudeau, T. Cassidy, S. Budman, S. Associations between public health indicators and injecting prescription opioids by prescription opioid abusers in substance abuse treatment. J Opioid Manag, 9 , pp. Gonzalez, M. Mimiaga, J. Israel, B. Andres, S. Substance use predictors of poor medication adherence: the role of substance use coping among HIV-infected patients in opioid dependence treatment. AIDS Behav, 17 , pp. Mateu-Gelabert, H. Guarino, L. Jessell, A. J Subst Abuse Treat, 48 , pp. Wolfe, M. Carrieri, D. Treatment and care for injecting drug users with HIV infection: a review of barriers and ways forward. Lancet, , pp. Degenhardt, C. Bucello, B. Mathers, C. Briegleb, H. Ali, M. Hickman, et al. Mortality among regular or dependent users of heroin and other opioids: a systematic review and meta-analysis of cohort studies. Havens, M. Lofwall, S. Frost, C. Oser, C. Leukefeld, R. Individual and network factors associated with prevalent hepatitis C infection among rural Appalachian injection drug users. Am J Public Health, , pp. Kinson, S. Guo, Y. Wan, V. Manning, H. Teoh, K. Burden of blood transmitted infections in substance users admitted for inpatient treatment in Singapore and the associated factors. Singapore Med J, 56 , pp. Ng, J. Chou, T. Chang, P. Lee, W. Shao, T. Lin, et al. High prevalence but low awareness of hepatitis C virus infection among heroin users who received methadone maintenance therapy in Taiwan. Addict Behav, 38 , pp. Roux, L. Fugon, J. Jones, S. Hepatitis C infection in non-treatment-seeking heroin users: the burden of cocaine injection. Am J Addict, 22 , pp. Rev Colomb Psiquiatr, 39 , pp. Barrio, M. Bravo, M. Brugal, M. Diez, E. Regidor, M. Belza, et al. Harm reduction interventions for drug injectors or heroin users in Spain: expanding coverage as the storm abates. Kidorf, V. King, N. Gandotra, K. Kolodner, R. Improving treatment enrollment and re-enrollment rates of syringe exchangers: month outcomes. Drug Alcohol Depend, , pp. Potier, V. Laprevote, F. Dubois-Arber, O. Cottencin, B. Supervised injection services: what has been demonstrated? A systematic literature review. Drug Alcohol Depend, C , pp. Subscribe to our newsletter. Instructions for authors Submit an article Ethics in publishing Language Editing services. Recommended articles. Addressing harmful alcohol use in primary care in Colombia A characterisation of social media users within the primary Article options. Addressing harmful alcohol use in primary care in Colombia: Understanding the sociocultural context. Characteristics of active users. Patients with opiate addiction. Patients on methadone treatment. Primary incomplete. Secondary incomplete. Secondary complete. University incomplete. Psychoactive substances. Opioid analgesics. Opiate use pattern and risk. Syringe and needle sharing. Opioid overdose. Mental illness. Hepatitis C. Hepatitis B. Characteristics of services. Origin of financial resources. EPS contracting. Individual patients. Public funding through local body. Public funding through national body. Origin of active patients. Treatment modalities. Hospital inpatient days. Other centres inpatient days. Initial dose of methadone mg. Dose increase during induction mg. Dose increase interval days. Dose reached in the first week mg. Maximum dose of methadone mg. Minimum dose of methadone mg. Supervised administration prior to administration at home days. Urine test frequency weeks.

Heroin Use and Injection Risk Behaviors in Colombia: Implications for HIV/AIDS Prevention

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Official websites use. Share sensitive information only on official, secure websites. Heroin production in Colombia has increased dramatically in recent decades, and some studies point to an increase in local heroin use since the mids. Despite this rapid increase, little is known about the effects of these activities on heroin injection within Colombia. One of the biggest concerns surrounding heroin injection is the potential spread of HIV through drug user networks. An HIV test was also administered. Information regarding the socio-demographics, injection drug use, HIV risk and transmission behaviors, injection risk management, and HIV knowledge and prevalence of participants are reported. The study identified many young, newly initiated injectors who engage in risky injection practices. The study also found that HIV prevalence is fairly low among participants 2. Findings indicate a potential risk for the spread of HIV among PWID in Colombia given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Colombia has a possibly time-limited opportunity to prevent an HIV epidemic by implementing harm reduction interventions among young, newly initiated PWID. In the early s, drug production in Colombia diversified to include heroin as well as cocaine Ciccarone, Despite this rapid increase in heroin production, little is known about the effects of these activities on heroin use within Colombia itself. This parallels research from other regions indicating that local heroin use eventually increases in geographic areas where it is produced. The escalation of heroin production and distribution in Asia, for instance, fostered heroin use among many Asian populations e. As the prevalence of heroin use in Colombia increased, so too did the incidence of heroin injection. The expansion of drug injection is the product of several factors, particularly the greater availability of cheap, low-quality, water-soluble heroin Miguez et al. The emergence of heroin injection in Colombia is worrisome for many reasons. One of the most unsettling is the potential spread of HIV through drug user networks and eventually to the general public. It presents the most current data available on heroin use patterns, specifically heroin injection, in Colombia. No significant differences were found. For this reason, data from both cities were pooled in the analyses to focus on heroin injection and associated risk behaviors in Colombia in general and to provide a foundation for future comparative research within the country. An explanation of the recruitment process was provided to interviewed participants, including the inclusion criteria i. For Pereira, the median network size was 10 while the range was 4—70 network members. No biases were found with regard to recruitment patterns by key demographic characteristics and injection risk behaviors. RDS-adjusted estimates for key demographics and HIV prevalence were similar to reported sample prevalence rates. Field researchers familiar with groups of local PWID conducted a structured interview with each participant that lasted for an average of 60 minutes. Among other topics, the survey included questions on demographics, drug use during the previous 6 months, drug injection and injection equipment sharing behaviors in the previous 6 months, last injection event, and HIV knowledge. In addition, a small blood sample was obtained from each participant via finger prick to administer laboratory based HIV testing. Confirmatory tests employed a Western Blot. All study participants provided written consent to participate in the study. All data presented are sample results not weighted population estimates calculated utilizing SPSS version Notably, almost all participants were male, and the sample was relatively young. Not all participants responded to all items. Thirty days prior to initiating injection, there was a high prevalence of drug use among participants. Table 2 presents information regarding injection drug use including the social contexts of injection initiation; duration and frequency of injection drug use; syringe combination syringe and needle access and scarcity; injection venues; and initiation of other injectors. First injection took place mostly in public spaces e. At the time of the interview, participants had injected for various lengths of time. By sample design, all participants injected heroin. When asked how many times per day they injected any drug in the previous 6 months, participants reported a mean of 3. Sixteen percent of participants injected at least once with a homemade syringe in the previous 6 months. Table 3 presents information regarding various risk and transmission behaviors associated with injection in the previous 6 months. Sharing of injection equipment was common among participants. Forty-two percent reported using previously used syringes provided by other PWID. Forty-nine percent of participants also reported sharing cookers, filters, or rinse water. Twenty-two percent of participants injected with syringes that were purchased pre-filled with drugs. In such instances, pre-filled syringes may have been previously used. Thirty-two percent of participants backloaded shared drugs by transferring the drug from one syringe into the back of another opened syringe with another PWID. Fifty-two percent of participants reported not sharing syringes. Sixty-two percent of participants reported giving his or her own used syringe to a close friend for injection. Forty-four percent of participants sold or were involved in selling drugs in exchange for money, drugs, material objects, or services. Seventeen percent of participants were paid to inject someone else a service that did not necessarily include provision of a syringe. Participants who used syringes that others had previously used indicated several reasons for doing so. Table 4 presents information regarding injection risk management practices among participants in the previous 6 months. Participants reported different frequencies of cleaning used syringes before injection. Table 5 presents information regarding HIV knowledge and prevalence among participants. Based on test results, HIV prevalence among participants was 2. Findings demonstrate a high frequency of syringe sharing, sharing of other injection equipment with multiple PWID, injection with pre-filled syringes, syringe cleaning practices of limited efficacy in preventing HIV transmission e. Findings also indicate a secondary market for syringes as well as syringe scarcity in both cities. This may be due to the lack of syringe exchange programs in either city, the cost limitation of purchasing syringes at pharmacies, and possible stigma faced by PWID when attempting to purchase syringes at pharmacies. This claim is further supported by testimony from local public health officials, peer educators, and researchers who work with drug users in Colombia; these local experts attest that injection drug use was very limited and never witnessed to such an extent prior to Furthermore, a considerable number of participants initiated new injectors, and these recently initiated injectors engage in risky injection practices. While HIV prevalence is still low 2. However, our findings indicate a potential risk for the spread of HIV among PWID given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Thus the timely introduction of harm reduction interventions could prevent an explosion in HIV prevalence, as has occurred in other countries Mathers et al. Interventions to train PWID in safer injection practices are likely to be facilitated by the fact that many participants in this study were already engaging in some efforts to clean their injection equipment, albeit with water. Although these practices are not fully effective in preventing HIV, they suggest a willingness to engage in safe injection practices. These PWID may be receptive to intervention because some are already taking steps to reduce harms, indicating a positive environment for bringing in harm reduction services that could quickly turn otherwise unsafe injection practices into much safer ones. Other harm reduction measures that have been effective in international settings in reducing the spread of HIV among PWID, including opioid substitution therapy, routine HIV testing for drug users, and knowledge dissemination about virus survival in contaminated injection equipment, could also prove useful in Colombia World Health Organization, If financial, political, or other obstacles prevent the implementation of such widespread interventions, another consideration, beyond humanitarian reasons, is the much lower cost of preventing HIV among PWID than treating infected individuals. Syringe exchanges could be key points of intervention by introducing sterile syringes to newly initiated injectors, thereby reducing the need for PWID to share and reuse nonsterile equipment. Pilot syringe exchange programs were also established in Pereira in with the support of the Ministry of Health and Justice and Open Society Foundations. The expansion of such programs is essential if they are to be effective in combating a potential HIV epidemic in Colombia. There are limits to the generalizability of the results from these two cities regarding PWID in other parts of Colombia. Research is needed in other Colombian cities and departments to understand the extent and nature of risk behaviors and HIV prevalence among heroin and other injectors across the country. Such research will demonstrate whether or not the results presented in this article apply more widely than these two cities. Other limitations include the fact that it is unclear from present data whether the syringes sold in exchange for money, drugs, material objects, or services, as well as the syringes purchased pre-filled with drugs, were used or sterile. More detailed information about these practices will help determine the degree of risk associated with them. The fact that the present study used respondent-driven sampling, which is considered to be nonrandom sample selection that must meet a number of assumptions to be considered a representative sample of the social network, could also be considered a limitation. Findings also suggest the existence of newly initiated injectors with limited knowledge of HIV prevention techniques in these cities. By highlighting the importance of such interventions in Colombia, this article underscores issues that may have important public health implications for other countries and regions faced with similar emerging heroin markets. Further research on heroin consumption in Colombia and heroin distribution routes to neighboring countries could serve as an early warning regarding the spread of heroin-related HIV epidemics elsewhere in Latin America. Points of view, opinions, and conclusions in this paper do not necessarily represent the official position of the U. A group of socially interconnected people who use drugs. Harm reduction refers to policies and practices intended to reduce the harms associated with drug use. Examples of harm reduction interventions include syringe exchange programs to help prevent the spread of HIV and HCV through the use of contaminated syringes and the provision of the opioid overdose reversal medication naloxone to drug users and their peers to help prevent death from opioid-associated overdose. A research sampling methodology that is particularly useful in accessing hard-to-reach populations, such as those who use illicit drugs. RDS combines chain-referral recruitment in which participants refer peers they know to the study with mathematical modeling in order to make unbiased estimates about the characteristics of hidden populations. The number or percent of individuals in a population who test positive for a disease in this paper, HIV at a given point in time, as measured by serology blood tests. Pedro Mateu-Gelabert , Ph. He has more than 50 peer-reviewed publications and has given numerous scientific presentations throughout the world. He received his Ph. Shana Harris , Ph. Harris specializes in ethnographic and qualitative research on drug use and abuse, global and public health, and science, technology, and medicine in Latin America and the United States. She has conducted research on such topics as harm reduction in Argentina, the utilization of buprenorphine in opiate addiction treatment in the San Francisco Bay Area, and recreational gamma hydroxybutyrate GHB use in Northern California. Harris is currently conducting research on medical travel and the use of ibogaine for drug treatment in Mexico. Dedsy Berbesi , Ph. She received her Ph. Her areas of work are infectious diseases such as tuberculosis, pneumonia and HIV as well as the use of psychoactive substances in school and university. In addition, for several years, she has been working with the injection drug using population and homeless people with measured prevalences of HIV and Hepatitis C in different cities of Colombia. She has worked as a research associate on several projects related to substance use and health mental. Her current research and teaching interests are on HIV. She has several publications on these topics. She has 20 years of experience working in the fields of drugs and HIV and worked for eight years with the La Casa Program of the University of the Andes dealing with topics such as drug use, HIV, and suicide where she trained and practiced in educational, clinical, preventative, and investigative fields. Since , she has assessed the Ministry of Health and Social Protection in the terms of public policy on health and social protection topics and in different phases of the construction, strengthening, and operationalization of harm reduction policy in Colombia at the national and sub-national levels. Lauren Jessell , LMSW, is a licensed social worker with experience spanning the areas of substance use and mental health policy, research, and clinical practice. Honoria Guarino , Ph. Her other research interests and activities include technology based behavioural health interventions for substance-using populations including individuals in methadone maintenance treatment, chronic pain patients who are misusing opioid medications, and youth in drug treatment. Samuel R. Friedman , Ph. He has published many poems in a variety of publications and a book of poetry Seeking to make the world anew: Poems of the Living Dialectic. Lanham, Maryland: Hamilton Books. The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article. As a library, NLM provides access to scientific literature. Subst Use Misuse. Published in final edited form as: Subst Use Misuse. Find articles by Pedro Mateu-Gelabert. Find articles by Shana Harris. Find articles by Dedsy Berbesi. Find articles by Lauren Jessell. Find articles by Honoria Guarino. Find articles by Samuel R Friedman. Issue date Jan PMC Copyright notice. The publisher's version of this article is available at Subst Use Misuse. Open in a new tab. Declaration of interest The authors report no conflicts of interest. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Drug use prior to injection initiation 30 days prior to first injection. Injection initiation a. Injection initiation venue a. Injection venue previous 6 months a , b. Initiating others into injection previous 6 months c. Number of people with whom shared syringes receptive sharing a. Provision of used syringes distributive sharing b. Reasons for sharing syringes b. Agents used to clean syringes a.

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