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Official websites use. Share sensitive information only on official, secure websites. Address correspondence to: Carla L. There is substantial evidence that alcohol, tobacco, and cannabis dependence problems surface more quickly when use of these drugs starts before adulthood, but the evidence based on other internationally regulated drugs e. With focus on an interval of up to 24 months following first drug use, we examine drug-specific and age-specific variation in profiles of early-emerging clinical features associated with drug dependence. The adolescent onset associated excess risk was not constant across all clinical features. Our evidence suggests promoting earlier detection and interventions, as well as greater parent and peer awareness of drug dependence clinical features that may develop early among young people who have just started using drugs. Keywords: Early-onset, drug dependence syndrome, clinical features, adolescents, adolescence, development. Some observers even express a view that preventing or delaying onset of drug use until adulthood might be sufficient to prevent occurrence of drug dependence syndromes. King and Chassin take a more sobering perspective; their evidence supports the idea that early-onset alcohol use is simply a marker and not a cause of later alcohol problems. Here, with a broad view across multiple psychoactive drug compounds and with control over length biases, this research project seeks new evidence on whether adolescent-onset users have excess risk for all measured clinical features of the drug dependence syndromes. The analyses clarify specific problems that emerge most rapidly within a 24 month interval after onset of use among adolescent-onset and adult-onset users. These public use datasets are made available so that investigators can design and complete their own novel analyses with respect to research questions not planned in advance. During the NSDUH computer-assisted interviews, each participant was asked a series of standardized survey items about extra-medical drug self-administration e. Next, a drug- and feature-specific slope model probes for a possibility that some clinical features have emerged more rapidly than others among the adolescent-onset as compared to the adult-onset users. All estimates involved an application of the NSDUH analysis weights with Taylor series linearization to accommodate the multi-stage nested cluster sampling plan. Estimated associations linking onset adolescent onset drug use age 11—17 with subsequent risk of clinical features within 24 months after first use, based upon a common slope model. Reference group: adults age 18 and above. Cannabis category includes: Marijuna and hashish e. Cocaine category includes: Cocaine hydrochloride powder, crack, free base, and coca paste. Inhalant category includes: amyl nitrite, correction fluid, gasoline fluid, glue, paint solvents, lighter gases, nitrous oxide, spray paints or other psychoactive aerosol sprays. Analgesic drugs include: prescription type pain relievers e,g. Anxiolytic medicines include: diazepam and meprobamate, as well as newer benzodiazepine compounds. Stimulants include methamphetamine, amphetamine, methylphenidate, and dextroamphetamine, or stimulants other than cocaine. For cannabis, adolescent-onset users more rapidly developed virtually all of the clinical features under study, as shown in Table 2. Estimated associations linking adolescent onset drug use age 11—17 with subsequent risk of clinical features within 24 months after first use using feature-specific slope model. Hallucinogen category includes: Hallucinogenic compounds e. NA, clinical feature not assessed for particular drug. We were unable to obtain the feature specific estimates for inhalants due to a non positive definite matrix in the model. In summary, based upon these US data about experiences of a nationally representative sample of recent-onset drug users during —2, we confirm an excess risk of developing clinical features associated with drug dependence when extra-medical drug use starts before age 18 versus during adulthood, for all drug groups under study except for hallucinogens. Whereas it might be argued that these observations might be traced back to differential item functioning e. Alternately, in co-twin research, escalation of later drug problems is not always completely explained by genetic or shared environmental influences Lynskey et al. Instead, early-onset drug use may reflect exposure to non-shared environmental or contextual factors that increase or reinforce a progression toward more advanced stages of drug involvement, which might include differences in micro- and macro-social environments, such as family drug-taking habits or socioeconomic status, and drug availability in the larger community or local neighborhood. In some prospective research, earlier drug availability but not lower socioeconomic status is predictive of cannabis smoking initiation and frequency of smoking; lower SES is more of an influence on development of cannabis dependence problems once smoking starts Hofler et al. Applying a developmental psychopathology perspective, one might look for explanations of the observed adolescence-associated excess risk in a drug-induced disruption of processes of adolescent brain development or possibly a higher threshold for reinforcement in neurochemical reward systems Chambers et al. Several limitations merit special attention, including reliance upon self-reports, although the NSDUH research seeks optimal response validity e. The nationally representative survey sampling frame and recruitment plan is of high quality, but excludes children under age 12, meaning that age 10—11 is an implicit lower age boundary for recent-onset and newly incident drug-taking. It will be a relatively easy matter to conduct new epidemiological research in an effort to replicate these results, now that NSDUH has released more recent national survey data. More intensive clinical and pre-clinical experiments may be required to probe deeply into the underlying mechanisms e. Nonetheless, based upon the epidemiological evidence available to date, and possibly for all but one of the drug categories under study i. If adolescent-onset is no more than a marker of excess risk, then randomized trials to evaluate drug prevention programs seeking delayed onset of drug use should make no difference in population-level estimates for incidence of drug dependence problems. This is evidence that can be secured via extended longitudinal followup assessment plans once randomized trials show that a promising drug prevention program actually has prevented or delayed the onset of adolescent drug use, years and even decades before the mechanisms of program action or excess risk are known thoroughly e. Data reported herein come from national survey data collected under the auspices of the Office of Applied Studies, Substance Abuse and Mental Health Services Administration. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. As a library, NLM provides access to scientific literature. Addict Behav. Published in final edited form as: Addict Behav. Find articles by Chuan-Yu Chen. Find articles by Carla L Storr. Find articles by James C Anthony. Issue date Mar. PMC Copyright notice. The publisher's version of this article is available at Addict Behav. Open in a new tab. More time getting drugs 2. Getting over the effects 4. Unable to keep to limits 2. More drugs same effect 3. Same amount less effect 3. Unable to cut down 5. Emotional problems 2. Physical problems 7. Reduced activities 3. Withdrawal symptoms NA 1. Feeling blue while cutting down NA 1. More time getting drugs 1. Getting over the effects 7. Unable to keep to limits 0. More drugs same effect 1. Same amount less effect 1. Unable to cut down 1. Physical problems 0. Reduced activities 1. Withdrawal symptoms 2. Feeling blue while cutting down NA NA 1. 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. Hallucinogens e. Analgesic drugs g j. Anxiolytic drugs h j. Stimulants i j. Analgesic drugs e , h. Anxiolytic medicines f , h. Stimulants g , h.

Mis-anaesthetized society: expectancies and recreational use of ketamine in Taiwan - PMC

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Harm Reduction Journal volume 18 , Article number: Cite this article. Metrics details. After implementing a nationwide harm reduction program in , a dramatic decline in the incidence of human immunodeficiency virus HIV infection among people with injection drug use IDU was observed in Taiwan. The harm reduction program might have sent out the message discouraging the choice of IDU among illicit drug users in early stage. A hierarchy of mutually exclusive categories of drug uses was defined by the drug with the highest schedule level among those tested positive in an arrest. Segmented regression analyses of interrupted time series were used to test for the impact of the intervention. There was a decrease of There were baseline decreasing trends in the first-time offense rate from to for heroin and ecstasy and an increasing trend for methamphetamine, with the slopes not altered by the intervention. The postintervention decrease in the first-time offense rate for heroin was detectable among offenders less than 40 years old. Our results indicate a diffusion effect of the intervention on decreasing heroin use among young offenders and have policy implications for better prevention and treatment for different age groups. Illicit drug use has been an important contributor to the global disease burden. An estimated 5. Globally, 1. Among them, injection drug use IDU has been of intense concern because of its increased risk of overdose-related death and contracting infections such as human immunodeficiency virus HIV and hepatitis C virus \[ 3 \]. Until the early s, IDU remained a challenging issue in regions such as Asia, where the incidence of HIV infection continued to increase \[ 4 \]. Despite empirical evidence showing that harm reduction programs are effective in decreasing IDU-related harm, their adoption was slow in Asia owing to the concern over spillover effects, such as the diversion of the opioid agonist medications \[ 5 , 6 \], sending a wrong or pro-drug message to the public \[ 7 \], and traditional emphasis on strict enforcement of punitive national antinarcotic laws \[ 8 , 9 , 10 \]. In the past three decades, Taiwan has witnessed drastic changes in drug use, and the government has developed policy changes over time. In the s, methamphetamine use surged, and it became the most common illicit drug for those incarcerated. Then, the classification of ecstasy was elevated to Schedule II i. Following a pilot carried out in four major sites in \[ 14 \], a three-pronged harm reduction program, including the expansion of extant education and screening, a needle—syringe program NSP , and the opioid substitution therapy OST \[ 13 , 15 \], was implemented nationwide, i. With a fast scaling-up in NSP sites that was rated as a successful model in a systemic review \[ 16 \], a dramatic decline in the incidence of HIV infection among people with IDU was observed \[ 17 \]. Under this circumstance, the harm reduction program might have sent out the message discouraging the choice of IDU among illicit drug users in early stage, resulting in a decrease in first-time offense rate of heroin. Furthermore, legal amendments to allow deferred prosecution nationwide were enacted in Then, in , another amendment to the law stipulated that any adult who used or possessed less than 20 g of ketamine, a Schedule III substance, would have to pay a fine and be forced to attend a drug seminar as their penalty; individuals would be criminally prosecuted if the weight was 20 g or more \[ 19 \]. The complexity of public health interventions in the real-world settings often poses methodological challenges for their evaluations \[ 20 \]. Recently, the Taiwanese government assembled electronic databases that enroll adults who were arrested for drug offenses. These databases cover all kinds of illicit drugs that tested positive and allow researchers to create national cohorts of first-time offenders, who were presumably in relatively early stage of illicit drug use \[ 23 \]. We hypothesized that after the nationwide implementation of harm reduction, the hidden community of illicit drug users would be more aware of the risk associated with IDU and might change from using injected drugs to those that could be administered orally or in other less invasive ways. To evaluate the variations in the use of different illicit drugs, we applied a hierarchical classification of illicit drugs if a person tested positive for more than two kinds of illicit drugs. We obtained study samples from two national databases of illicit drug offenses in Taiwan. Data were retrieved from both databases from their initiation date until the end of Data cleaning procedures were conducted by excluding those without a valid identification number and those aged 80 or over. The nationwide harm reduction program implemented by the Taiwanese government in consisted of three parts \[ 13 , 14 , 15 \]. The first part was called information, education, and communication via expansion of existing screening and education service to people with IDU, with emphasis on avoiding the reuse of drug paraphernalia and the sharing of dissolved heroin solution \[ 24 \]. The second part was the NSP that distributed clean needles and syringes and collected used ones for safe disposal, as well as distributed free condoms and educational materials regarding the prevention of blood or sexually transmitted disease. In a fast scaling-up in the first year, Taiwan Centers for Disease Control established NSP sites that were either pharmacy-based NSP sites or vending machines and distributed , items of needles—syringes in \[ 13 \]. The third part was the OST provided in a number of public hospitals, where HIV-infected person with IDU could receive methadone treatment free of charge owing to the support by a special governmental funding for the control of HIV, while HIV seronegative ones were charged ca. In the first year, there were 21 OST clinics with cases on treatment \[ 13 \]. Both the number of needles—syringes distributed in NSP sites and the number of cases on OST clinics continued to increase in subsequent years and peaked in \[ 13 \]. Every arrest involving an illicit drug offense was enlisted in either the CRPS or APS and was called a drug offense event in this study. However, the two databases did not have information about whether an arrestee had a previous offense record. Following our previous study \[ 23 \], we adopted an operational approach toward the classification of drug offenders. First, we classified the drug arrest events by calendar year. Then, we counted the unique individuals in each year as prevalent offenders. Finally, the first year that an offender appeared in the databases was determined, and the offender was classified as a first-time offender in that particular year. Any appearance of the offender in the database after that year led the person to be classified as a repeat offender. We adopted a hierarchy of mutually exclusive categories of drug use following the principle of a previous study \[ 25 \]. Based on the age-specific rate of both prevalent and first-time offenders, we then calculated an age-standardized offense rate using the World Standard population WHO — \[ 26 \], truncated to the age range between 18 and 69 years, as the weighting for the population. Then, we used segmented regression analysis of interrupted time series to evaluate the impact of a policy change on the yearly age-standardized first-time offense rate, in which the time period was divided into pre- and postintervention segments, and separate intercepts and slopes were estimated in each segment \[ 27 \]. Briefly, we specified the following linear regression model to estimate the level and trend in the age-standardized yearly first-time offense rate before the harm reduction program and the changes in level and trend following the harm reduction program:. All statistical analyses were conducted using SAS version 9. From to , a total of , drug offenses were committed by , persons referred to as prevalent offenders hereafter , , of whom were first-time drug offenders Additional file 1 : Table S1. When a hierarchical classification of illicit drug offenses was applied, the distribution of different categories of illicit drugs from to is shown in Table 1. The first-time offense rates for hierarchically classified five categories of illicit drugs, including heroin, methamphetamine, ecstasy, ketamine-criminal use, and ketamine-noncriminal use, from to are shown in Fig. Yearly age-standardized first-time offense rate from to for five hierarchically classified kinds of illicit drugs, including heroin, methamphetamine, ecstasy, ketamine CRPS, i. For the three most common categories of illicit drugs that tested positive prior to , i. After stepwise elimination of nonsignificant terms, the most parsimonious model was derived for each category of illicit drugs Table 2. As shown in Fig. In contrast, the first-time offense rate of methamphetamine had an increasing trend 0. Yearly age-standardized first-time offense rate from to in Taiwan with the most parsimonious model in segmented regression analysis that had an intervention in for a heroin, with a three-parameter model; b methamphetamine, with a two-parameter model; and c ecstasy, with a two-parameter model. In addition to the trends revealed in the segmented regression analysis for heroin, methamphetamine, and ecstasy, Fig. The rate of noncriminal ketamine use first surpassed that of heroin in , then surpassed that of methamphetamine in , and peaked in After that, the rate of noncriminal use of ketamine started to decline steadily and substantially over the year, whereas that of methamphetamine use increased to a plateau. Next, we examined the yearly first-time offense rates of hierarchically classified drug categories separately for four age groups Fig. Before , heroin was the most commonly tested positive illicit drug for all age groups except the youngest one of 18—24 years old, in which methamphetamines and ecstasy were intertwined with heroin. Meanwhile, with the adoption of the administrative penalty against recreational use of ketamine in , its first-time offense rates increased rapidly among the two youngest groups 18—24 and 25—29 years old , even surpassing that of methamphetamines. In contrast, for the oldest two groups 30—39, and 40—49 years old , the first-time offense rates for ketamine increased moderately but did not exceed that of methamphetamine for the group of 30—39 years old and remained extremely low for the oldest groups 40—49 years old. The relevant data for Fig. Yearly first-time offense rate from to for five hierarchically classified kinds of illicit drugs, including heroin, methamphetamine, ecstasy, ketamine-criminal prosecution, and ketamine-administrative penalty, in Taiwan from to separately for the age groups of a 18—24 years old, b 25—29 years old, c 30—39 years old, and d 40—49 years old. Using segmented regression analysis of the yearly first-time offense rates from to , this study found that there was a decrease of Additionally, there were decreasing trends in the first-time offense rate from to for heroin and ecstasy and an increasing trend for methamphetamine, with the slopes not altered by the intervention. When examined in five different age groups, the postintervention decrease in the first-time offense rate for heroin was detectable among the youngest three groups 18—24, 25—29, and 30—39 years old but not seen for the groups of 40—49 and 50—59 years old. Additionally, the newly regulated recreational use of ketamine since the end of quickly gained popularity and became the most common illicit drug that tested positive among first-time offenders younger than 30 years old. Our results provide empirical support for a diffusion effect of the intervention on decreasing heroin use among young offenders and have policy implications for better prevention and treatment for different age groups. The evaluation whether drug users' choice of illicit drugs was influenced by an intervention, such as the implementation of a nationwide harm reduction program, presents several methodological challenges. The first challenge is the lack of reliable epidemiological estimates of unsanctioned drug use \[ 28 \]. In this aspect, the drug arrest data that have been verified using urine tests can be helpful \[ 29 \]. In a previous study relying on the results of the indicated urine tests, which did not separate repeated offenses from first-time offenses, heroin use did not decrease in the first three years after the implementation of a harm reduction program \[ 13 \]. It remains unknown whether the choice of illicit drugs among first-time offenders was different from that among repeat offenders. The third challenge is that alterations in the preferred categories of illicit drugs might be influenced by other concurrent changes. For example, the emergence of so-called club drugs \[ 30 \] or party drugs \[ 31 \] in the early s led to substantial changes in the landscape of illicit drug use, especially among young people, in many countries, including Taiwan \[ 32 , 33 \]. To meet these challenges, time series data that can be subjected to segmented regression analysis are needed for the evaluation of the impact of an intervention \[ 21 , 22 , 27 \]. The feasibility of our analyses of the first-time offenses for illicit drugs was mainly based on a combination of the availability of various information, including the verification of drug use by urine tests, national drug enforcement databases that included all illicit drug offenses, and a comprehensive listing of illicit drugs tested positive in each arrest. Owing to the long period — covered by these databases, we could apply segmented regression to quantitatively evaluate the impact of the intervention on heroin use among first-time offenders. Under the traditional harsh punishment stipulated in antinarcotic laws in Asia \[ 8 \], many countries in this region have been reluctant to adopt harm reduction programs to tackle the increase in the incidence of HIV \[ 4 \]. After the Taiwanese government responded to the spike of the HIV epidemic by adopting the three-pronged harm reduction program in , outcome evaluations were focused on the remarkable decline in HIV incidence among people who injected drugs \[ 13 , 15 , 34 \]. For the first time, this study provides new insight into the discouraging or diffusion effect Clarke and Weisburd, ; Guerette, of the harm reduction program on heroin use among first-time illicit drug offenders. Based on the yearly first-time offense rates for individual categories of hierarchically classified illicit drugs derived in this study, heroin was the most common drug that tested positive among the first-time illicit drug offenders in the early s. One explanation is that individuals with a first arrest for an illicit drug offense heroin might have used other illicit drugs previously. The results of segmented regression analysis revealed that among the three most commonly used illicit drugs prior to the intervention, only heroin exhibited a postintervention decrease in the first-time offense rate. It appears that the diffusion effect of the nationwide harm reduction program was specific to drugs administered mainly via injection. Additionally, all three drugs had a baseline trend, i. Under this circumstance, the intervention-induced decrease of In other words, despite a decreasing trend in the first-time offense rate for heroin that was already in place in the early s, the intervention did help to accelerate the decline in heroin use within a year. Furthermore, the intervention-induced decrease in heroin use was found to be greater for younger age groups. Hence, this diffusion effect on heroin use is likely to be associated with changes in drug use culture among young people. It is plausible that the hazard of contracting HIV by means of IDU might have spread more easily to the community of younger drug users and prevented them from using heroin. Nevertheless, an intervention for IDU might also lead to crime displacement \[ 36 \]. There was a growing popularity of party or club drugs among young people \[ 32 , 33 \]. Examining the first-time offense rates for individual categories of illicit drugs during the study period, it was found that ketamine increased steadily from its enrollment in late and became the most common drug that tested positive in , especially among offenders younger than 30 years old. The popularity of ketamine use was initially noted after another rave-associated drug, ecstasy, was elevated to Schedule II in \[ 11 \], which accounted for the decreasing trend of ecstasy use since the beginning of the period covered by this study. Drug dealers began to promote ketamine over ecstasy because ketamine consumption would not lead to incarceration \[ 32 \]. Following a legal amendment in , even noncriminal possession of ketamine i. Intriguingly, the popularity of ketamine began to drop after reaching its peak in To a lesser extent, methamphetamine might also contribute to a small proportion of the decline in heroin use among first-time illicit drug offenders, since it had a borderline increasing trend at baseline. Notably, methamphetamine, the predominant illicit drug in the s \[ 11 \], has re-emerged as the top drug of choice among first-time offenders since , following the decline of recreational use of ketamine in The long-standing popularity of methamphetamine is probably attributed partly to the fact that the drug can be easily made by transnational criminal organizations in small clandestine laboratories, with relatively inexpensive over-the-counter ingredients. Taken together, the nationwide implementation of harm reduction program in did succeed in reducing the incidence of HIV infection among people with IDU and decreasing heroin use among first-time offenders as well. Nevertheless, this does not necessarily imply it would be equally effective in the control of HIV transmission due to other risk factors \[ 39 \]. In fact, a separate sexually transmitted HIV outbreak involving mainly men who have sex with men MSM continued to rise exponentially since in Taiwan \[ 45 , 46 , 47 \]. Accompanying this, there appeared to be an increasing trend of recreational drug use among MSM \[ 48 \]. An online anonymous survey from December to January among participants of a MSM social network found that Furthermore, MSM were found to have increased risk of non-opioid recreational drug use \[ 50 \]. Our findings have implications for the control policy of illicit drug use. Many countries in Asia have been hesitant to implement harm reduction responses when facing HIV epidemics among people with IDU \[ 8 , 9 , 10 \]. One concern was that such an approach might have implicit consent for IDU and could lead to an increase in heroin use. Our results indicate that the implementation of a nationwide harm reduction program not only led to a remarkable decline in HIV incidence among people with IDU but also had a diffusion effect on decreasing heroin use among first-time illicit drug offenders. Nevertheless, our results also revealed that the decline in the first-time offense rate for heroin was partly offset by the increase in the first-time offense rate for methamphetamine and ketamine. Given that the recidivism and mortality rate of both methamphetamine \[ 51 \] and ketamine \[ 23 \] have been found to be high, this poses new challenges for their prevention and treatment. A further warning about the re-emergence of methamphetamine is that it has become a new drug of choice for injection use among MSM \[ 49 \]. New approaches, such as a combination of both medical and psychosocial interventions of sufficient intensity \[ 13 \], warrant further development to alleviate the surge of recreational use of party drugs. This study has several limitations. First, the enforcement of laws related to illicit drug use might be influenced by factors unrelated to drug regulation. Hence, we do not know about injection patterns or motivation for such use. Third, we do not have symptom or comorbidity information. Fourth, the current databases do not contain other criminal record data. Finally, this study did not have information about drug market changes over time. To what extent the change in certain first-time illicit drug use could be accounted for by market availability remains unknown. In summary, the intervention via nationwide implementation of a harm reduction program helped to accelerate the drop in heroin use among young first-time illicit drug offenders. Before , ketamine seemed to be a substitute for heroin in this age group. Further investigation into evidence-based alternative ways to prevent and treat the use of specific categories of illicit drugs is urgently needed. The datasets analyzed during the current study are not publicly available due to the requirement of obtaining official permission to access the data, but are available from the corresponding author on reasonable request. United Nations Office on Drugs and Crime. World Drug Report Executive Summary: Conclusions and Policy Implications. 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Design characteristics and statistical methods used in interrupted time series studies evaluating public health interventions: a review. J Clin Epidemiol. First-time offenders for recreational ketamine use under a new penalty system in Taiwan: incidence, recidivism and mortality in national cohorts from to Excess mortality among people who report lifetime use of illegal drugs in the United States: A year follow-up of a nationally representative survey. Drug Alcohol Depend. GPE Discussion Paper series no. Geneva: WHO; Segmented regression analysis of interrupted time series studies in medication use research. J Clin Pharm Ther. Global statistics on addictive behaviours: status report. Am J Public Health. Subst Use Misuse. Maxwell JC. Party drugs: properties, prevalence, patterns, and problems. Use of ecstasy and other psychoactive substances among school-attending adolescents in Taiwan: national surveys — BMC Public Health. Using social network as a recruiting tool for research on substance use in the Taipei metropolitan area: Study design, implementation, and epidemiological estimates. J Epidemiol. Changes in HIV incidence among people who inject drugs in Taiwan following introduction of a harm reduction program: a study of two cohorts. PLoS Med. Heroin use among youths incarcerated for illicit drug use: psychosocial environment, substance use history, psychiatric comorbidity, and route of administration. Am J Addict. J Exp Criminol. Market Analysis of Synthetic Drugs: Amphetamine-type stimulants, new psychoactive substances. Ministry of Health and Welfare. Taipei: Ministry of Health and Welfare; Sypsa V. Why do HIV outbreaks re-emerge among people who inject drugs? Lancet HIV. Luxembourg: Publications Office of the European Union; Characteristics of analytically confirmed illicit substance-using patients in the Emergency Department. J Formos Med Assoc. Differences in prevalence, sociobehavioral correlates, and psychosocial distress between club drug and hard drug use in Taiwan: Results from the National Survey of Substance Use. J Acquir Immune Defic Syndr. Molecular epidemiology of HIV-1 infection among men who have sex with men in Taiwan in Molecular epidemiology of HIV-1 infection among men who have sex with men in Taiwan from to Arch Sex Behav. Factors associated with methamphetamine dependency among men who have sex with men engaging in chemsex: Findings from the COMeT study in Taiwan. Non-opioid recreational drug use and a prolonged HIV outbreak among men who have sex with men in Taiwan: an incident case-control study, — J Formos Med Assoc Three-year mortality and predictors after release: a longitudinal study of the first-time drug offenders in Taiwan. Download references. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Wei J. You can also search for this author in PubMed Google Scholar. All authors contributed to critical revision of the manuscript for important intellectual content and approved the final version prior to publication. Correspondence to Wei J. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Table S1. Number of illicit drug offences in events , from schedule I to IV, and offenders in persons , aged 18—69, —, Taiwan. Table S2. Number of first-time illicit drug offenders in Taiwan, —, stratified by sex and age groups. Table S3. Time series modeling with segmented regression that contains four parameters of age-standardized first-time offence rates per , for heroin, methamphetamine, and ecstasy, respectively, from to in Taiwan. Table S4. Age-standardized first-time offence rate for hierarchically classified illicit drugs in Taiwan, —, stratified by age groups: a 18—24 years old; b 25—29 years old; c 30—39 years old; d 40—49 years old; and e 50—59 years old. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Chen, W. Harm Reduct J 18 , Download citation. Received : 23 September Accepted : 03 November Published : 19 November Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Abstract Background After implementing a nationwide harm reduction program in , a dramatic decline in the incidence of human immunodeficiency virus HIV infection among people with injection drug use IDU was observed in Taiwan. Results There was a decrease of Conclusions Our results indicate a diffusion effect of the intervention on decreasing heroin use among young offenders and have policy implications for better prevention and treatment for different age groups. Background Illicit drug use has been an important contributor to the global disease burden. Methods Study samples We obtained study samples from two national databases of illicit drug offenses in Taiwan. The nationwide harm reduction program The nationwide harm reduction program implemented by the Taiwanese government in consisted of three parts \[ 13 , 14 , 15 \]. Classification of drug offenders Every arrest involving an illicit drug offense was enlisted in either the CRPS or APS and was called a drug offense event in this study. Statistical analysis Based on the age-specific rate of both prevalent and first-time offenders, we then calculated an age-standardized offense rate using the World Standard population WHO — \[ 26 \], truncated to the age range between 18 and 69 years, as the weighting for the population. Results First-time offenders From to , a total of , drug offenses were committed by , persons referred to as prevalent offenders hereafter , , of whom were first-time drug offenders Additional file 1 : Table S1. Table 1 Hierarchical classification of the first-time illicit drug offenders in Taiwan, — Full size table. Table 2 Time series modeling of age-standardized first-time offense rates for heroin and methamphetamine, from to in Taiwan Full size table. Table 3 Time series modeling of age-standardized first-time offense rates for heroin from to in Taiwan, separately for five age groups Full size table. Full size image. Discussion Using segmented regression analysis of the yearly first-time offense rates from to , this study found that there was a decrease of Implications Our findings have implications for the control policy of illicit drug use. Limitations This study has several limitations. Conclusion In summary, the intervention via nationwide implementation of a harm reduction program helped to accelerate the drop in heroin use among young first-time illicit drug offenders. Availability of data and materials The datasets analyzed during the current study are not publicly available due to the requirement of obtaining official permission to access the data, but are available from the corresponding author on reasonable request. Article Google Scholar Bell J. Article Google Scholar Thomson N. Article Google Scholar Download references. Acknowledgements The authors thank Dr. Hsien-Ho Lin for his help with the design of the study. Chen View author publications. View author publications. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Additional information Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Supplementary Information. Additional file 1. About this article. Cite this article Chen, W. Copy to clipboard. Contact us Submission enquiries: journalsubmissions springernature.

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