Exploration of the physical health of dual users of heroin and crack in methadone treatment who inject or have previously injected drugs

Journal article

Heidebrecht, F., Macleod, M.B. and Dawkins, L. (2021). Exploration of the physical health of dual users of heroin and crack in methadone treatment who inject or have previously injected drugs. Heroin Addiction And Related Clinical Problems.
AuthorsHeidebrecht, F., Macleod, M.B. and Dawkins, L.
Abstract

1.1 Background
Heroin use in methadone treatment is more common for dual users of heroin and crack/cocaine, and intravenous use increases the risk of health complications. The aim of this study was to explore the physical health of intravenous drug users in methadone treatment with a focus on dual users.
1.2 Methods
We analyzed the clinical records of 241 drug users with a history of injecting heroin and receiving methadone in two treatment services in London, UK, and conducted structured interviews with a subsample of 28 dual users. Statistical analyses included logistic regression and cluster analysis.
1.3 Results
Poor health correlated positively with history of crack use, age, methadone dose, current injecting and negatively with age of first drug use. The prevalence of poor health was higher in those injecting both drugs compared to those smoking crack. Clustering analysis highlighted further possible determinants of health including reverse transition from injecting to smoking, high-risk injecting, cardiovascular risk.
Higher methadone dose was not always associated with better health in dual users and individual factors played a relevant role in stopping injecting at a range of methadone doses. Client’s accounts on their experience of methadone treatment highlighted harm-reduction benefits of methadone beyond only abstinence.
1.4 Conclusions
Our results suggest that dual users of heroin and crack are more likely to be in worse health compared to heroin-only users and that the physical health is multi-factorial. Services could capitalize on clients’ health beliefs as motivators towards safer practices or abstinence and focus more on health-related outcomes.

Keywordsheroin; health; crack; addiction; methadone; treatment; injecting; dual users
Year2021
JournalHeroin Addiction And Related Clinical Problems
PublisherAssociazione per l'Utilizzo delle Conoscenze Neuroscientifiche a fini Sociali (AU-CNS)
ISSN1592-1638
Publication dates
Print01 Feb 2022
Publication process dates
Accepted24 Mar 2021
Deposited30 Apr 2021
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Correction: Global and local perspectives on tobacco harm reduction: What are the issues and where do we go from here? [Harm Reduct J., 15, (2018) (32)] DOI: 10.1186/s12954-018-0239-5
Cox, S and Dawkins, L (2018). Correction: Global and local perspectives on tobacco harm reduction: What are the issues and where do we go from here? [Harm Reduct J., 15, (2018) (32)] DOI: 10.1186/s12954-018-0239-5. Harm Reduction Journal. 15 (1), p. 37. https://doi.org/doi.org/10.1186/s12954-018-0242-x
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Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health
Dawkins, LE, Soar, K and Papaioannou, G (2016). Alcohol Gel Ingestion Among Homeless Eastern and Central Europeans in London: Assessing the Effects on Cognitive Functioning and Psychological Health. Substance Use and Misuse. https://doi.org/10.3109/10826084.2016.1168441
Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects
Dawkins, LE, Kimber, C., Doig, M, Feyerabend, C and Corcoran, O (2016). Self-titration by experienced e-cigarette users: blood nicotine delivery and subjective effects. Psychopharmacology. 233 (15), pp. 2933-2941. https://doi.org/10.1007/s00213-016-4338-2
E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure (study protocol)
Dawkins, LE, Cox, SA, Kosmider, L, McRobbie, H, Goniewicz, M, Kimber, CF and Doig, M (2016). E-cigarette puffing patterns associated with high and low nicotine e-liquid strength: effects on toxicant and carcinogen exposure (study protocol). BMC Public Health. 16. https://doi.org/10.1186/s12889-016-3653-1
Adolescent awareness and use of electronic cigarettes: A review of emerging trends and findings
Dawkins, LE, Greenhill, R, Notley, C, Finn, M and Turner, J (2016). Adolescent awareness and use of electronic cigarettes: A review of emerging trends and findings. Journal of Adolescent Health. 59 (6), pp. 612-619. https://doi.org/10.1016/j.jadohealth.2016.08.005
Recreational cocaine use is associated with attenuated latent inhibition
Soar, K., Dawkins, L., Page, F. and Woolridge, J. (2015). Recreational cocaine use is associated with attenuated latent inhibition. Addictive Behaviors. 50 (34-39). https://doi.org/10.1016/j.addbeh.2015.06.010
The effects of e-cigarette visual appearance on craving and withdrawal symptoms in abstinent smokers
Dawkins, L., Munafo, M., Christoforou, G., Olumegbon, N. and Soar, K. (2015). The effects of e-cigarette visual appearance on craving and withdrawal symptoms in abstinent smokers. Psychology of Addictive Behaviors. 30 (1), pp. 101-105. https://doi.org/10.1037/adb0000112
Acute electronic cigarette use: nicotine delivery and subjective effects in regular users
Dawkins, L. and Corcoran, O. (2014). Acute electronic cigarette use: nicotine delivery and subjective effects in regular users. Psychopharmacology. 231 (2), pp. 401-407. https://doi.org/10.1007/s00213-013-3249-8
First‐ versus second‐generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms
Dawkins, L., Kimber, C., Puwanesarasa, Y. and Soar, K. (2014). First‐ versus second‐generation electronic cigarettes: predictors of choice and effects on urge to smoke and withdrawal symptoms. Addiction. 110 (4), pp. 669-677. https://doi.org/10.1111/add.12807
Water consumption, not expectancies about water consumption, affects cognitive performance in adults
Edmonds, C.J., Crombie, R., Baillieux, H., Gardner, M.R. and Dawkins, L. (2013). Water consumption, not expectancies about water consumption, affects cognitive performance in adults. Appetite. 60, pp. 148-153. https://doi.org/10.1016/j.appet.2012.10.016
Vaping? profiles and preferences: an online survey of electronic cigarette users
Dawkins, L. (2013). Vaping? profiles and preferences: an online survey of electronic cigarette users. UEL Research and Knowledge Exchange Conference 2013. London 26 Jun 2013 University of East London.
Neuropsychological effects associated with recreational cocaine use
Soar, K., Mason, C., Potton, A. and Dawkins, L. (2012). Neuropsychological effects associated with recreational cocaine use. Psychopharmacology. 222, pp. 633-643. https://doi.org/10.1007/s00213-012-2666-4
The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition
Dawkins, L., Turner, J.J.D., Hasna, S. and Soar, K. (2012). The electronic-cigarette: effects on desire to smoke, withdrawal symptoms and cognition. Addictive Behaviors. 37, pp. 970-973. https://doi.org/10.1016/j.addbeh.2012.03.004
Investigating the impact of nicotine on executive functions using a novel virtual reality assessment
Jansari, A.S., Froggatt, D., Edginton, T. and Dawkins, L. (2012). Investigating the impact of nicotine on executive functions using a novel virtual reality assessment. Addiction. 108, pp. 977-984.
Nicotine derived from the electronic cigarette improves time-based prospective memory in abstinent smokers
Dawkins, L., Turner, J.J.D. and Crowe, E. (2012). Nicotine derived from the electronic cigarette improves time-based prospective memory in abstinent smokers. Psychopharmacology. 227, pp. 377-384.
Effects of nicotine and alcohol on affective responses to emotionally toned film clips
Dawkins, L. and Powell, J (2011). Effects of nicotine and alcohol on affective responses to emotionally toned film clips. Psychopharmacology. 216, pp. 197-205. https://doi.org/10.1007/s00213-011-2197-4
Expectation of having consumed caffeine can improve performance and mood
Dawkins, L., Shahzad, F.-Z., Ahmed, S.S and Edmonds, C.J. (2011). Expectation of having consumed caffeine can improve performance and mood. Appetite. 57, pp. 597-600. https://doi.org/10.1016/j.appet.2011.07.011
Relapse to smoking during unaided cessation: clinical, cognitive, and motivational predictors
Powell, J.H., Dawkins, L., West, R., Powell, J.F. and Pickering, A. (2010). Relapse to smoking during unaided cessation: clinical, cognitive, and motivational predictors. Psychopharmacology. 212, pp. 537-549. https://doi.org/10.1007/s00213-010-1975-8
Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence
Dawkins, L., Powell, J.H., Pickering, A., Powell, J. and West, R. (2009). Patterns of change in withdrawal symptoms, desire to smoke, reward motivation and response inhibition across 3 months of smoking abstinence. Addiction. 104, pp. 850-858. https://doi.org/10.1111/j.1360-0443.2009.02522.x
The effects of cigarette smoking and abstinence on auditory verbal learning
Soar, K., Dawkins, L., Begum, H. and Parrott, A.C. (2008). The effects of cigarette smoking and abstinence on auditory verbal learning. Human Psychopharmacology: Clinical and Experimental. 23, pp. 621-627. https://doi.org/10.1002/hup.968
The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips
Dawkins, L., Acaster, S. and Powell, J.H. (2007). The effects of smoking and abstinence on experience of happiness and sadness in response to positively valenced, negatively valenced, and neutral film clips. Addictive Behaviors. 32, pp. 425-431. https://doi.org/10.1016/j.addbeh.2006.05.010
A double-blind placebo controlled experimental study of nicotine: II - Effects on response inhibition and executive functioning
Dawkins, L., Powell, J.H., West, R., Powell, J. and Pickering, A. (2007). A double-blind placebo controlled experimental study of nicotine: II - Effects on response inhibition and executive functioning. Psychopharmacology. 190, pp. 457-467. https://doi.org/10.1007/s00213-006-0634-6
A double-blind placebo controlled experimental study of nicotine: I - Effects on incentive motivation
Dawkins, L., Powell, J.H., West, R., Powell, J. and Pickering, A. (2006). A double-blind placebo controlled experimental study of nicotine: I - Effects on incentive motivation. Psychopharmacology. 189, pp. 355-367. https://doi.org/10.1007/s00213-006-0588-8
Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation
Powell, J.H., Pickering, A.D., Dawkins, L., West, R. and Powell, J.F. (2004). Cognitive and psychological correlates of smoking abstinence, and predictors of successful cessation. Addictive Behaviors. 29, pp. 1407-1426. https://doi.org/10.1016/j.addbeh.2004.06.006
Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model
Powell, J.H., Dawkins, L. and Davis, R.E. (2002). Smoking, reward responsiveness, and response inhibition: tests of an incentive motivational model. Biological Psychiatry. 51, pp. 151-163. https://doi.org/10.1016/S0006-3223(01)01208-2