Abstract
Background
Evidence supports integrating drug use treatment, harm reduction, and HIV prevention services to address dual epidemics of drug use disorders and HIV. These dual epidemics have spurred a rise in legally-enforced compulsory drug abstinence programs (CDAP), despite limited evidence on its effectiveness. We conducted a systematic review and meta-analysis evaluating the association between CDAP exposure and HIV and overdose-related risk.
Methods
We searched PubMed, EBSCOhost and Sociological Abstracts for studies that contained an individual-level association between CDAP exposure and related HIV or overdose risks, with no date restrictions. Meta-analyses were conducted on data abstracted from eligible studies, using pooled random-effects models and I-squared statistics. We assessed quality of the studies across 14 criteria for observational studies.
Results
Out of 2,226 abstracts screened, we included 8 studies (5253 individuals/776 events) across China, Mexico, Thailand, Norway, and the United States. All but two were cross-sectional analyses, limiting strength of observed associations. In the two studies that reported association between CDAP and HIV seropositivity or receptive syringe sharing, findings were inconsistent and did not indicate that those with exposure to CDAP had increased odds of HIV or syringe sharing. However, we found the odds of experiencing non-fatal overdose in lifetime and in the last 6-12 months were 2.02 (95% CI 0.22 - 18.86, p = 0.16) to 3.67 times higher (95% CI 0.21 - 62.88, p = 0.39), respectively, among those with CDAP exposure than those without.
Conclusion
Research assessing HIV risk associated with CDAP is scant and inconclusive, while evidence of robust associations between CDAP and overdose risk continues to mount. More rigorous, longitudinal studies are needed to evaluate the causal relationships between CDAP and these health outcomes. Aside from the growing evidence base on collateral harms, ethical considerations dictate that voluntary, evidence-based drug treatment should be prioritized to address the drivers of excess morbidity and mortality among people who use drugs.
Evidence supports integrating drug use treatment, harm reduction, and HIV prevention services to address dual epidemics of drug use disorders and HIV. These dual epidemics have spurred a rise in legally-enforced compulsory drug abstinence programs (CDAP), despite limited evidence on its effectiveness. We conducted a systematic review and meta-analysis evaluating the association between CDAP exposure and HIV and overdose-related risk.
Methods
We searched PubMed, EBSCOhost and Sociological Abstracts for studies that contained an individual-level association between CDAP exposure and related HIV or overdose risks, with no date restrictions. Meta-analyses were conducted on data abstracted from eligible studies, using pooled random-effects models and I-squared statistics. We assessed quality of the studies across 14 criteria for observational studies.
Results
Out of 2,226 abstracts screened, we included 8 studies (5253 individuals/776 events) across China, Mexico, Thailand, Norway, and the United States. All but two were cross-sectional analyses, limiting strength of observed associations. In the two studies that reported association between CDAP and HIV seropositivity or receptive syringe sharing, findings were inconsistent and did not indicate that those with exposure to CDAP had increased odds of HIV or syringe sharing. However, we found the odds of experiencing non-fatal overdose in lifetime and in the last 6-12 months were 2.02 (95% CI 0.22 - 18.86, p = 0.16) to 3.67 times higher (95% CI 0.21 - 62.88, p = 0.39), respectively, among those with CDAP exposure than those without.
Conclusion
Research assessing HIV risk associated with CDAP is scant and inconclusive, while evidence of robust associations between CDAP and overdose risk continues to mount. More rigorous, longitudinal studies are needed to evaluate the causal relationships between CDAP and these health outcomes. Aside from the growing evidence base on collateral harms, ethical considerations dictate that voluntary, evidence-based drug treatment should be prioritized to address the drivers of excess morbidity and mortality among people who use drugs.
| Original language | English |
|---|---|
| Article number | 103401 |
| Number of pages | 10 |
| Journal | International Journal of Drug Policy |
| Volume | 96 |
| Early online date | 11 Aug 2021 |
| DOIs | |
| Publication status | Published - 1 Oct 2021 |
Bibliographical note
Funding Information:This study was supported by funding from the National Institute on Drug Abuse (K01DA043421), Fogarty International Center, NIAID/NIDA (R01 AI147490), and UCSD Center for AIDS Research (P30 AI036214). AB acknowledges support from NIDA (DP2 DA049295). LB also acknowledges funding by Open Society Foundations? Public Health Program grant. The funders had no role in the design of the study, data collection, analysis, interpretation of findings, writing of the manuscript, or submission of the paper for publication.
Funding Information:
This study was supported by funding from the National Institute on Drug Abuse ( K01DA043421 ), Fogarty International Center, NIAID/NIDA (R01 AI147490), and UCSD Center for AIDS Research (P30 AI036214). AB acknowledges support from NIDA (DP2 DA049295). LB also acknowledges funding by Open Society Foundations’ Public Health Program grant. The funders had no role in the design of the study, data collection, analysis, interpretation of findings, writing of the manuscript, or submission of the paper for publication.
Publisher Copyright:
© 2021 Elsevier B.V.
Keywords
- Compulsory drug abstinence program
- PWUD
- PWID
- Drug treatment
- Civil commitment
- Harm reduction
- Overdose
- HIV