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Philadelphia tries a housing program devoted exclusively to opioid users. Treatment is their choice. After 20 years on heroin and six years living on the street, Anthony Messina just moved into a home of his own: a small one-bedroom, comfortably furnished and completely free. The Housing First model has been used for years to get chronically homeless people off the street. Many are seriously mentally ill, and quite a few are on drugs. Suburbs in both Pennsylvania and New Jersey have embraced it. But Philadelphia's experiment is unusual: a team of professionals devoted exclusively to opioid users, set up in advance of the city's crackdown on the homeless heroin encampment along the Conrail tracks, and expanded since. The concept: First provide housing, not in a shelter but a real apartment or a house. Then surround the newly housed with an intensive array of service s — regular medical and psychiatric care, help with benefits, education, even showing them how to shop and do laundry. And treatment to stay off drugs. The program is costly, but still far less expensive than the constant ER visits, hospitalizations, and prison stints common to people living on the street. It has money to house 75 people; so far, 53 are in their new homes. Just after 9 a. They zipped through updates. A staffer got her some tokens but she needed a replacement pass. Another woman had signed up to volunteer at a food bank, which seemed a smart way to get free food. Department of Housing and Urban Development. Tenants pay 30 percent of their income toward rent and utilities, but most on this team — who have generally been on the streets for years — have no income at all. Treatment is always a goal. More than 40 percent of Team 7's clients chose to start medication-assisted treatment, which studies indicate is the most effective option; the staff helped arrange it. And a third more have expressed interest. Every Pathways employee carries Narcan, the overdose-reversal drug, even when going to fix a broken toilet. They have never needed it for a client, but have revived others they've spotted unconscious on the street. Three Team 7 clients have died of drug-related causes. Still, Tice said, if they had been homeless, 'they easily could have died earlier. Anthony Messina's slight body shows the wear of repeated injuries from hard living. His gray hair is in a short ponytail, his face unshaven. He smiles easily and moves deliberately. At a ShopRite en route to the apartment, he scrutinized the circular for specials. Then rolls, bacon, eggs, tuna, milk, ice cream. Gabriel Kalmuss-Katz, a social worker helping him move, hung back but observed something missing: 'Vegetables? Kalmuss-Katz asked whether he had anything to move in besides the groceries. Messina pointed to his T-shirt and baggy pants. Other than prison — some five dozen arrests, mainly for shoplifting, selling small amounts of drugs, violating probation — Messina has rarely strayed far from where he grew up in South Philly, a few blocks from the tourist-clogged corner dominated by Geno's and Pat's King of Steaks. He was living at home in when a perceived slight — something about dope and a favored sibling — led him to tell his mother to drop dead. He remembers standing under I to get out of the rain and thinking there weren't as many rats as he'd expected. About 10 people stayed there. It is close to where I was panhandling,' Messina said. The city of Philadelphia oversees more than 10, housing units, from shelter beds to apartments. Some have bad reputations, others strict rules. Chronically homeless people often prefer to stay on the street. No one has turned down an apartment on Team 7, although some, such as Messina, wait until there's something available in a neighborhood they know. A special team for opioid users made sense, said Liz Hersh, director of the city's Office of Homeless Services. On the street 'there is no future. This gives them a future. Even so, studies have found that Housing First saves more than it costs. Researchers reported in JAMA in that a Seattle program for chronically homeless people with severe alcohol problems cut the cost of government services by more than half after just six months compared with people still on the street. Some small studies have found these housing initiatives also help people get clean. The most recent large analysis , from Canada, did not. But with all its proven benefits, Henwood, like most in his field, supports the notion. His bedroom was down the hall. The water pressure in the shower was good. A week later, an ex-girlfriend came for a couple of days. She stole his TV while he was out. He called the police. Messina last shot heroin before a late-August jail stint on a contested probation violation. After being released, he stayed away from it. He s aid he doesn't care for the heroin that is available these days. Sometimes mixed with the powerful opioid fentanyl, he finds it unsatisfying, not to mention potentially deadly. He's on Suboxone, a medication that treats opioid addiction by helping him avoid painful withdrawal symptoms. For now. Skip to content. Share Icon. Link Icon. Facebook Logo. Link copied to clipboard. In Philly, finding a place for the homeless on opioids. X Facebook Instagram.

In Philly, finding a place for the homeless on opioids

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Methamphetamine Heroin kerack Women Treatment. Iran borders Afghanistan, the main opium producer in the Middle East region 1. Studies show that Iran has the highest per capita opioid use in the world 1. In recent years, a new locally produced synthetic heroin which is colloquially named heroin kerack has hit Iranian illicit drug market and its abuse is epidemic among Iranian drug users 3. Heroin kerack not to be mistaken with crack cocaine belongs to Iran only and contains diacetylmorphine mixed with some adulterants including acetylcodeine, 6-monoacetylmorphine, caffeine, papaverine, noscapine, dextromethorphan, morphine, codeine, phenobarbital and diazepam 3. The main route of heroin kerack abuse is smoking but, the appearance of heroin kerack as a purified and highly potent form of heroin has been also cited as a potent driver of injection practice in Iran 4. There is evidence that heroin kerack and MA abuse have become critical health concerns among drug abusers in Iran. Some drugs such as MA are frequently co-abused with other drugs, including alcohol 7 , marijuana and depressants 8. A study showed that reducing negative affect is a strong motivation to co-abuse heroin with MA 9. An increasing number of studies have suggested that as a psychostimulant drug, MA abuse poses a serious health risk on illicit opioid users 10 - 12 , especially on women but Iranian women experience greater social stigma from being drug abusers and are less likely to seek treatment As a result, no considerable information on female drug abusers is available in Iran 4. In , a study on 78 women at a free methadone clinic with ancillary services for female drug abusers in the south of Tehran showed that opium and heroin abuse e. Co-use of heroin kerack with MA could have critical health implications but there is a paucity of research on this issue in Iran especially on drug-abusing women who recreationally or regularly co-use heroin kerack with MA. As a result, motivations and reasons associated with initial and continued co-use of heroin kerack with MA are unknown and the treatment needs of this vulnerable group are unrecognized. The current study aims to investigate the reasons associated with initial and continued co-use of heroin kerack with MA, motivations associated with treatment entry and to compare the general characteristics of two groups of regular and recreational female co-users at a DIC in Tehran. Between March and September , a cross-sectional study was conducted at a female-specific DIC in the south of Tehran a low socio-economic area with problematic drug use problem. Of drug users referring to the DIC, 82 participants were co-users of heroin kerack with MA and were randomly recruited. After providing informed consent, participants were interviewed by forth well-trained female psychologists. Exclusion criteria included 1 withdrawal and or intoxication symptoms, and 2 disagreement with signing consent form. A questionnaire was designed to conduct interviews. Three psychiatrists also adapted the questionnaire according to the situation in Iran, which was followed by a pretest assessment on a sample of women treatment seekers in the south of Tehran. The validity of the questionnaire was obtained from reviewing the previous studies 16 , The questionnaire included assessments of socio-demographic characteristics, substance use and injecting drug use practices, high risk behaviors, factors associated with initial and continued co-use of heroin kerack with MA, and motivations for treatment entry. Descriptive statistics characterized demographic characteristics, substance use details, high risk behaviors, initial and continued co-use of heroin kerack with MA, and motivations for treatment entry. We compared the differences between the two groups using the Chi-square test for categorical variables and t-test for continuous variables. Interviews were conducted individually and participants were assured of the confidentiality of interviews. An identification code was included on each questionnaire. Participants were ensured that non-participation in the study would not affect their treatment and harm-reduction service utilization. Participants reported having children between none and four children Table 1. Multiple drug detecting urine tests which had been registered by the physician of the DIC at registration in their clinic files confirmed their self-report of co-use of heroin kerack with MA. Regular users reported that they co-used heroin kerack with MA in Duration of participation in the current treatment was 9. Participants reported different motivations associated with initial co-use of heroin kerack with MA. As a result, by co-use, they attempted to regularly substitute MA use for stopping heroin kerack use. Regular co-users were more likely to be single Regular co-users were younger No relationship was found between the other study variables. The study findings showed that participants were commonly young, married, homemaker, and with low level of education. Marital status of most participants was single or separated and women were much less likely to report full time employment and unemployment Findings of the current study may be indicative of the traditional roles of women in a developing country. Additionally, the current study participants initiated drug use at a young age with drugs of less detrimental effects such as hashish and then made a transition to co-use of heroin kerack with MA as drugs of more detrimental impacts on health. Findings of the current study showed that the participants experienced a transition from the traditional patterns of drug use in Iran to new patterns of drug use at relatively a young age and rapidly experienced continued use and dependence. A study showed that an earlier initiation of drug use is associated with more possibility for continued drug use The transition from traditional drugs of abuse to new ones and co-use of heroin kerack with MA among these women should be considered for treatment because there is evidence that the current trend is increasing to some extent as rapidly as that of men. Studies in other countries showed that high use rates of some drugs are emerging for women, equivalent to those of men High risk behaviors such as sex work, unprotected sex, and drug injection were reported by a group of the current study participants which are subjects to training in safe sex, safe injection and prevention. A study showed that MA use increased the risk for engaging in multiple sex partners, and risky sexual intercourse among adults 18 - 24 years old High risk behaviors among participants are likely to be partly due to MA use and deserve further research. Participants reported that heroin kerack use had negative depressant impacts on their everyday life. Apparently, there is no study to show that the depressant effects of heroin kerack use would be inevitably negated by using MA, or vice versa. Combining drugs that individually have a complex effect on physical and psychological aspects inevitably complicates things even further, making these executive operations less predictable and more subject to error among users. Findings of the current study showed implications for immediate drug education. Curiosity was an important initial factor for co-use of heroin kerack with MA too. Witteveen et al. Another study on initiation of MA use among 48 young Thai MA users in Chiang Mai city and the suburbs emphasized the role of curiosity at initiation Lack of knowledge on addictive effects of MA use and assuming that MA was a non-addictive drug which could be used to quit heroin kerack was another important reason at initiation. This issue was followed by MA substitution to quit heroin kerack use and is a new study finding in the current study. A study on MA users in the US showed that later MA order in the initiation sequence was partly related to initiating MA to substitute for another drug Dependence on co-use of heroin kerack with MA and drug availability was two reasons for continued co-use of heroin kerack with MA. The Study on the etiology of continued drug use among women is not well-documented. Some sporadic studies showed that women used heroin more frequently or more likely to be diagnosed with heroin dependence compared with men 25 , and drug availability is an important reason for drug use among women Detrimental physical and psychological effects of co-use of heroin kerack with MA were important motivations for some participants to enter treatment. This is consistent with an old study in Sweden showed that women were more likely to seek treatment after serious acute complications of their drug use such as unconsciousness This study finding implicates implementing prevention and treatment programs for these women. The current study participants frequently reported that although they combined MA use with their regular heroin kerack use but they believed that they were at risk for making a transition from co-use of heroin kerack with MA to MA abuse only. No study was found to compare the current study findings with, but this issue implicates urgent drug use prevention programs for these women. Fear from making a transition from smoking heroin kerack with MA to injection was another important factor for treatment entry which should be considered in designing treatment and harm reduction programs for this group of drug users. This issue may be partly due to high stigma that the Iranian community imposes on injection and social observations that these women had from cases that made a transition from drug smoking to drug injection. No study was also found to compare this finding with, but this issue implicates implementing prevention programs that target those aspects of drug use which these women consider important. The descriptions of regular and recreational co-users showed that some demographic and drug use-related characteristics were different between regular and recreational users which are likely to make them vulnerable to the regular pattern of co-using heroin kerack with MA. Findings of the current study can provide a basis to develop prevention and treatment strategies based on the patterns of co-use of heroin kerack with MA and should be specifically considered in designing and tailoring treatment programs for recreational and regular co-users of heroin kerack with MA. The current study confirms the importance of certain demographic and drug use characteristics associated with co-use of heroin kerack with MA. These issues were likely to lead some of heroin kerack-dependent participants to a high risk situation to co-use heroin kerack with MA regularly but further research is required to assess the nature of these associations. As the MA epidemic among Iranian female heroin Kerack users continues to grow, the need for research on etiology and effective treatment outcomes increase. Moreover, drug-using women experience stigma of being drug users and are reluctant to seek treatment Some studies conducted in recent years, have shown that drug use treatment programs specifically developed for women have increased effective treatment outcomes Implementing comprehensive treatment programs addressing different personal, familial, social and cultural needs of women have become an important practice These results should be interpreted within the limitations of the study. The study findings emphasize some important reasons associated with initiation, continued use of heroin kerack with MA, motivations to enter treatment and some differences between regular and recreational co-users of heroin kerack with MA that may have implications for female-specific research as well as for prevention and treatment. Because of the exploratory nature of the current study, the results of this study cannot be generalized to other female heroin kerack and MA co-users in Iran. Further studies with more representative samples are suggested. Afghanistan opium survey. Vienna: Vienna: United Nations; Afghanistan Opium Survey. Street-level heroin seizures in Iran: a survey of components. J Subst Abuse. HIV risk behavior among injection drug users in Tehran, Iran. Abstract book of Fifth Addiction congress in Zahedan. Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran. Harm Reduct J. Alcohol addiction of methamphetamine abusers in Japan. J Forensic Sci. Methamphetamine treatment rapidly inhibits serotonin, but not glutamate, transporters in rat brain. Brain Res. Logan B. Methamphetamine-effects on human performance and behavior. Forensic Science Review. Increasing use and associated harms of crystal methamphetamine injection in a Canadian setting. Drug Alcohol Depend. Drug Alcohol Rev. Impaired physical health among methamphetamine users in comparison with the general population: the role of methamphetamine dependence and opioid use. Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran. The establishment of a methadone treatment clinic for women in Tehran, Iran. Journal of Public Health Policy. Characteristics of Iranian women seeking drug treatment. J Womens Health Larchmt. J Subst Abuse Treat. WHO drug injecting study phase II-study questionnaire. Available from cedoc. A multi-site comparison of psychosocial approaches for the treatment of methamphetamine dependence. Kandel D, Davies M. Progression to regular marijuana involvement: Phenomenology and risk factors for near-daily use. In: Glantz M, Pickens R, editors. Vulnerability to drug use. Annual report on adult and juvenile arrestees. Washington, DC: U. Baskin-Sommers A, Sommers I. The co-occurrence of substance use and high-risk behaviors. J Adolesc Health. Factors associated with the initiation of cocaine and heroin among problem drug users: reflections on interventions. Subst Use Misuse. Initiation of methamphetamine use among young Thai drug users: a qualitative study. Substance use pathways to methamphetamine use among treated users. Addict Behav. Assessing the needs of women in institutional therapeutic communities. J Offender Rehabil. Gender differences at admission and follow-up in a sample of methadone maintenance clients. Dahlgren L, Myrhed M. Female alcoholics. Ways of admission of the alcoholic patient. A study special reference to the alcoholic female. Acta Psychiatr Scand. Effectiveness of substance abuse treatment programming for women: a review. Am J Drug Alcohol Abuse. We use cookies to provide you with the best possible experience. They also allow us to analyze user behavior in order to constantly improve the website for you. Abstract Background: Co-use of heroin kerack with methamphetamine MA is a new epidemic health concern among Iranian female drug users. Yet, little is known about this issue because of stigma. Objectives: The current study aimed to investigate the reasons associated with initial and continued co-use of heroin kerack with MA among two groups of regular and recreational female co-users, their motivations associated with treatment entry and to compare their general characteristics at a drop in center DIC in Tehran. Materials and Methods: 82 clients were randomly recruited. A researcher-designed questionnaire was used to collect data. Data was analyzed by performing descriptive statistics, the Chi-square test and t-test. Conclusions: Reasons associated with initial and continued co-use of heroin kerack with MA, factors associated with treatment entry and the differences between regular and recreational co-users should be specifically considered in designing and tailoring drug use treatment programs for this group. Background Iran borders Afghanistan, the main opium producer in the Middle East region 1. Objectives The current study aims to investigate the reasons associated with initial and continued co-use of heroin kerack with MA, motivations associated with treatment entry and to compare the general characteristics of two groups of regular and recreational female co-users at a DIC in Tehran. Materials and Methods 3. Design and Setting Between March and September , a cross-sectional study was conducted at a female-specific DIC in the south of Tehran a low socio-economic area with problematic drug use problem. Measures A questionnaire was designed to conduct interviews. Results 4. Demographic Characteristics 82 participants who had enrolled for treatment participated in the study. Table 1. Table 2. Table 3. References 1. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4. Leave a comment here:. Cookie Setting We use cookies to provide you with the best possible experience.

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