Ricky Bluthenthal | University of Southern California (original) (raw)

Papers by Ricky Bluthenthal

Research paper thumbnail of Overdose Education and Naloxone Distribution Within Syringe Service Programs — United States, 2019

Morbidity and Mortality Weekly Report, Aug 21, 2020

Research paper thumbnail of Gang Involvement and Drug Use Histories Among People Who Inject Drugs in California: A Retrospective Analysis

Journal of Drug Issues, Jun 6, 2019

We examined whether gang membership history was associated with earlier age of first drug use, fi... more We examined whether gang membership history was associated with earlier age of first drug use, first drug injection, and shorter time to injection (TTI) drug use among people who inject drugs (PWID). PWID (N = 438) were interviewed in California (2011-2013). Surveys addressed demographics, current/former drug use practices, gang membership, and parental drug use. Multivariate analyses were conducted to identify whether gang membership history was associated with age at first drug use, first injection drug use, and TTI. Gang membership was reported by 23% of sample. Gang membership history was associated with earlier ages of first drug use (-1.35 years; 95% confidence interval [CI]= [−0.50, −2.20]), age at first injection (-1.89 years; 95% CI = [0.00, −3.78]), but not TTI. Gang involvement facilitates drug use including earlier age of first injection drug use.

Research paper thumbnail of Measures of harm reduction service provision for people who inject drugs

Bulletin of The World Health Organization, Jun 20, 2019

Measuring the effectiveness of needle and syringe programmes Daniel O'Keefe et al.

Research paper thumbnail of Individual-level needle and syringe coverage measurement as an international harm reduction planning and monitoring tool

Drug and Alcohol Review, Oct 31, 2019

Research paper thumbnail of Retailers' Perceptions of FDA Tobacco Regulation Authority

Tobacco regulatory science, May 1, 2019

Objectives:Research is limited on tobacco retailers’ perceptions of the Food and Drug Administrat... more Objectives:Research is limited on tobacco retailers’ perceptions of the Food and Drug Administration’s (FDA) tobacco regulatory authority overall, and less exists related to retailers in predominantly African-American or other racial/ethnic neighborhoods. We assessed differences in perceptions of the FDA’s tobacco regulatory authority and barriers to compliance among retailers in African-American and non-African-American neighborhoods in Los Angeles, California.Methods:Overall, 700 tobacco retailer interviews assessed demographic characteristics and perceptions of the FDA.Results:Retailers in African-American neighborhoods self-identified as Hispanic/Latino (43.9% vs 39.6% non-African-American), African-American (21.2% vs 2.6% non-African-American) or Asian (19.7% vs 19.5% non-African-American). Retailers in African-American neighborhoods were significantly less likely to perceive the FDA as a trustworthy source (p = .03; vs non-African-American), but more likely to report that they do not know the federal rules (p = .002), do not understand the federal rules (p = .004), and that tobacco companies encourage them not to follow the federal rules (p = .04).Conclusions:Tobacco control agencies can use this information about retailer perceptions to design education/training materials in order to increase trust, mitigate barriers, and enhance compliance.

Research paper thumbnail of Buprenorphine implementation at syringe service programs following waiver of the Ryan Haight Act in the United States

Drug and Alcohol Dependence, Aug 1, 2022

Research paper thumbnail of The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA

Drug and Alcohol Dependence, Aug 1, 2021

BACKGROUND Opioid overdoses are a leading cause of injury death in the United States. Providing p... more BACKGROUND Opioid overdoses are a leading cause of injury death in the United States. Providing people who inject drugs (PWID) with naloxone is essential to preventing deaths. However, research regarding gaps in naloxone delivery is limited. METHODS We interviewed 536 PWID in San Francisco and Los Angeles, California from 2017 to 2018. We described naloxone engagement and re-engagement cascades, and identified factors associated with receiving naloxone in the past six months and currently owning naloxone. RESULTS The engagement cascade showed 72 % of PWID ever received naloxone, 49 % received it in the past six months, and 35 % currently owned naloxone. The re-engagement cascade showed, among PWID who received naloxone in the past six months, 74 % used and/or lost naloxone, and 67 % refilled naloxone. In multivariable analyses, identifying as Latinx (aRR = 0.53; 95 % CI: 0.39, 0.72) and Black (aRR = 0.73; 95 % CI: 0.57, 0.94) vs White were negatively associated with receiving naloxone in the past six months, while using opioids 1-29 times (aRR = 1.35; 95 % CI: 1.04, 1.75) and 30+ times (aRR = 1.52; 95 % CI: 1.17, 1.99) vs zero times in the past 30 days and witnessing an overdose in the past six months (aRR = 1.69; 95 % CI: 1.37, 2.08) were positively associated with receiving naloxone in the past six months. In multivariable analyses, being unhoused vs housed (aRR = 0.82; 95 % CI: 0.68, 0.99) was negatively associated with currently owning naloxone. CONCLUSIONS Our study adds to the literature by developing naloxone engagement and re-engagement cascades to identify disparities. Naloxone scale-up should engage populations facing inequitable access, including people of color and those experiencing homelessness.

Research paper thumbnail of Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach

Harm Reduction Journal, May 28, 2022

Background: Opioid-related overdose deaths have surged in the USA over the last two decades. Over... more Background: Opioid-related overdose deaths have surged in the USA over the last two decades. Overdose fatalities are preventable with the timely administration of naloxone. Syringe service programs (SSP) have pioneered community-based naloxone distribution through overdose prevention and naloxone distribution (OEND) programs. There is a dearth of information with regards to best practices for community-based OEND. Methods: We utilized a modified Delphi approach to develop a set of best practices for OEND delivery. Starting with an initial list of best practices, we engaged 27 experts, in the field of OEND programming who reviewed, made recommendations for changes, and assigned a priority to each best practice. Results: Two rounds of input resulted in a final list of 20 best practices organized into four categories. The mean priority scores ranged from 1.17 to 2.17 (range 1 to 3). The top 5 ranked best practices were ensuring that SSP participants have low barrier, consistent, needs-based access to naloxone and that there is ample naloxone available within communities. While the remaining fifteen best practices were deemed important, they had more to do with organizational culture and implementation climate. Conclusions: Increasing community-based OEND delivery is essential to reduce opioid overdose deaths; however, it will be insufficient to add programs without an eye toward quality of implementation and fidelity to the model upon which the evidence is based. This list of best practices summarizes the consensus among OEND experts and can serve as a tool for SSPs providing OEND programming to improve services.

Research paper thumbnail of Initiating Persons into Injection Drug Use in Rural West Virginia, USA

Substance Use & Misuse, Oct 8, 2019

Background: While prior research has explored factors associated with people who inject drugs (PW... more Background: While prior research has explored factors associated with people who inject drugs (PWID) initiating others into drug injection in urban settings, very little work has been done to understand this behavior among rural PWID in Appalachia. Objectives: We aim to identify factors associated with PWID initiating injection-naïve individuals into drug injection in a rural community in West Virginia (WV). Methods: Data were derived from a cross-sectional survey of 420 rural PWID (163 women) in Cabell County, WV in June-July 2018 who indicated recent (past 6 months) injection drug use. Individuals completed a survey that included measures on socio-demographics and injection socialization behaviors. We used logistic regression to identify factors associated with PWID recently initiating someone for their first injection.

Research paper thumbnail of Transition from injecting opioids to smoking fentanyl in San Francisco, California

Drug and Alcohol Dependence, Oct 1, 2021

BACKGROUND The introduction of illicitly made fentanyl in the United States has slowly replaced h... more BACKGROUND The introduction of illicitly made fentanyl in the United States has slowly replaced heroin. New illicit drugs are often associated with changes in frequency and modes of administration. We assessed changes in injection frequency and smoking fentanyl in the new era of fentanyl availability in San Francisco. METHODS We used targeted sampling to recruit 395 people who inject drugs (PWID) into an observational cohort study in San Francisco 2018-2020. We assessed changes in injection frequency, opioid injection frequency and fentanyl smoking frequency in four six-month periods. We also conducted qualitative interviews with PWID asking about motivations for injecting and smoking opioids. RESULTS The median number of past-month injections steadily decreased by semi-annual calendar year from 92 injections in July to December 2018 to 17 injections in January to June 2020. The rate of opioid injections reduced by half (Adjusted Incidence Rate Ratio = 0.41; 95 % Confidence Interval = 0.25, 0.70; p < 0.01). The number of days smoking fentanyl was associated with fewer number of injections (X2(2) = 11.0; p < 0.01). Qualitative interviews revealed that PWID's motivation for switching from injecting tar heroin to smoking fentanyl was related to difficulties accessing veins. After switching to smoking fentanyl, they noticed many benefits including how the drug felt, improved health, fewer financial constraints, and reduced stigma. CONCLUSION Between 2018 and 2020, there was a shift from injecting tar heroin to smoking fentanyl in San Francisco. Reductions in injection of illicit drugs may offer public health benefit if it reduces risk of blood-borne viruses, abscesses and soft-tissue infections, and infective endocarditis.

Research paper thumbnail of Refining a Multicomponent Intervention to Increase Perceived HIV Risk and PrEP Initiation: Focus Group Study Among Black Sexual Minority Men

JMIR Formative Research

Background Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decreas... more Background Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decrease HIV incidence among Black sexual minority men (BSMM). However, BSMM perceive others as PrEP candidates instead of themselves and are less likely than other groups to use PrEP if prescribed. Peers and smartphone apps are popular HIV prevention intervention tools typically used independently. However, they could be useful together in a multicomponent strategy to improve perceived HIV risk and PrEP initiation for this group. Information regarding attitudes and preferences toward this multicomponent strategy is limited. Objective The goal of this study is to obtain attitudes and perspectives regarding the design of a multicomponent intervention that uses a smartphone app and a peer change agent (PCA) to increase perceived HIV risk and PrEP initiation. The intervention will be refined based on thematic findings for a culturally responsive approach. Methods Data were obtained guided by life ...

Research paper thumbnail of Assessing overdose education and naloxone distribution within syringe service programs throughout the United States" (IS01)

Addiction Science & Clinical Practice, Dec 30, 2020

Research paper thumbnail of Factors associated with methamphetamine withdrawal symptoms among people who inject drugs

Drug and Alcohol Dependence, 2021

BACKGROUND Regular methamphetamine (MA) use can result in withdrawal syndrome characterized by fa... more BACKGROUND Regular methamphetamine (MA) use can result in withdrawal syndrome characterized by fatigue, agitation, depression, and anxiety. No studies that we are aware of have examined the prevalence and predictors of MA withdrawal symptoms among people who inject drugs (PWID). METHODS PWID were recruited using targeted sampling methods in Los Angeles and San Francisco, California from 2016 to 2017. Survey questions included demographics, drug use, and MA withdrawal symptoms, frequency, and symptom severity. Participants who reported regular MA use (> 12 times in the last 30 days) were included in this analysis (N = 595). Multivariable regression models were developed to examine factors associated with any MA withdrawal, withdrawal frequency, symptom severity, and receptive syringe sharing. RESULTS MA withdrawal symptoms in the past 6 months were reported by 53 % of PWID, with 25 % reporting weekly withdrawal symptoms, and 20 % reporting very or extremely painful symptoms. In multivariable logistic regression, presence of any MA withdrawal symptoms was positively associated with more frequent MA use and non-injection tranquilizer use and inversely associated with crack cocaine use. Among those reporting any withdrawal, female sex was associated with more frequent withdrawal symptoms. Very or extremely painful withdrawal symptoms were associated with being in residential treatment. Receptive syringe sharing was associated with any MA withdrawal symptoms and weekly frequency of symptoms. CONCLUSION MA withdrawal symptoms are common among PWID and are associated with receptive syringe sharing. Strategies for implementing MA use treatment, safe supply programs, and syringe services programs targeting people who inject MA are indicated.

Research paper thumbnail of Prevalence and predictors of recent temporary psychiatric hold among a cohort of people who inject drugs in Los Angeles and San Francisco, California

Drug and Alcohol Dependence, 2021

California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH)... more California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of individuals who present a danger to themselves or others and/or may be gravely disabled due to mental illness. Little is known about the frequency and predictors of involuntary holds among people who inject drugs (PWID). METHODS We sought to identify the prevalence and predictors of recent TPHs (within the past 12 months) among a community-recruited sample of PWID in Los Angeles and San Francisco, California during 2017-2018 (N = 531). Multivariable logistic regression modeling was used to evaluate demographic (e.g., age), economic (e.g., homelessness), drug use (e.g., types of drugs used), incarceration (e.g., recent arrest history) and mental health (e.g., lifetime mental health diagnosis) variables associated with recent TPH. RESULTS Age (40-49 years old vs age 50 or older: AOR = 5.85; 95 % CI = 2.18, 15.67), current homelessness (AOR = 3.75; 95 % CI = 1.28, 11.0), lifetime mental health history (AOR = 6.23; 95 % CI = 2.08, 18.66), and frequency of methamphetamine use (AOR = 1.01; 95 % CI = 1.00, 1.01) were statistically associated with increased odds of having experienced a TPH, while frequency of past month heroin/opioid use was associated with decreased odds of reporting a TPH (AOR = 0.99; 95 % CI = 0.99, 1.00) in multivariable analysis. CONCLUSIONS Diverse factors were associated with TPH among PWID. Our analysis underscores the need for research on PWID with co-occurring substance-use and mental illness disorders and homelessness. There is urgent need for expanding access to lower barrier publicly funded mental health treatment from a harm-reduction approach.

Research paper thumbnail of Small Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex With Men (BMSM)

AIDS Education and Prevention, 2020

We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve eng... more We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve engagement in HIV/STI prevention and services to improve social determinants of health among Black men who have sex with men (BMSM) using incentives and peer support. We assessed PtW's impact on HIV/STI screening and pre/post-exposure prophylaxis (PrEP/PEP) knowledge/uptake using a randomized trial that compared the full intervention to one lacking peer support. We compared changes within groups surveyed at baseline and 6 months. We enrolled 80 eligible BMSM, among 399 screened. Among retained participants (34 peer-supported; 27 comparison), overall increases were observed in HIV (30% to 87% p < .001) and STI (28% to 80% p < .001) testing within the prior 6 months, as well as in PrEP and PEP awareness, and PrEP use. Statistically significant between group differences were not observed. Tailored prevention planning, incentives, and addressing social determinants may help move Black...

Research paper thumbnail of Initial Efficacy of a Community-Derived Mindfulness-Based Intervention for Latinx Parents and their Children

Journal of Immigrant and Minority Health, 2021

Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress... more Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress, enhance emotion regulation, and foster social support. We assessed pilot data from Latinx parents in Eastside Los Angeles (n = 27) matched with their children aged 10–16 (n = 32) to determine whether participation in a community-derived MBI was associated with greater improvements in dispositional mindfulness, perceived stress, emotion regulation, and family social support compared to a control condition. Compared to the control group, parents in the MBI group showed greater reductions in perceived stress scale (PSS) scores (B = − 2.94, 95% CI [− 5.58, − 0.39], p = 0.029), while their children reported greater increases in perceived social support from family (B = 2.32, 95% CI [0.26, 4.38], p = 0.027). Findings show a community-derived MBI may improve stress in Latinx parents and social support for their children.

Research paper thumbnail of Factors associated with health-related cannabis use intentions among a community sample of people who inject drugs in Los Angeles and San Francisco, CA 2016 to 2018

Drug and Alcohol Dependence, 2021

Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensar... more Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensaries, but less is known about motivations in community samples of opioid-using people who inject drugs. Our objective is to describe cannabis use motivations associated with self-treatment of physical pain, emotional issues, and as an opioid substitute. Methods: Data come from 6-month follow-up interviews with people who inject drugs who participated in a study on the efficacy of an injection initiation prevention intervention in Los Angeles and San Francisco, California from 2016− 18. The analytic sample consists of 387 people who inject drugs who reported past-month cannabis use. We developed multivariable logistic regression models by reported cannabis use motivations: physical pain relief, emotional problems, and opioid substitute. Results: The most common cannabis use motivations reported by people who inject drugs was to "get high," relieve physical pain and emotional problems, and reduce opioid use. In separate multivariate models, using cannabis for physical pain relief was associated with higher odds of using cannabis as a substitute for opioids; cannabis for emotional problems was associated with being diagnosed with depression; and cannabis as a substitute for opioids was associated with non-prescribed, non-injection methadone use. Conclusion: People who inject drugs reported using cannabis for health-related motivations. This motivation aligns with health needs and suggests the acceptability of cannabis use for health reasons in this population. Studies to determine the medical effectiveness of cannabis products for these common health and mental health needs among people who inject drugs are needed.

Research paper thumbnail of Novel Routes of Potential Hepatitis C Virus Transmission among People Who Inject Drugs: Secondary Blood Exposures Related to Injection Drug Use

Substance Use & Misuse, 2021

Abstract Background: The US is in the midst of a national Hepatitis C Virus (HCV) epidemic that a... more Abstract Background: The US is in the midst of a national Hepatitis C Virus (HCV) epidemic that appears to be driven by new cases among people who inject drugs (PWID). While HCV transmission among PWID is believed to occur mostly through direct sharing of syringes, some infections may be spread via secondary processes and materials involved in injecting. Objectives: Here, we present the prevalence of secondary blood exposures on clothing and nearby surfaces after injection episodes and examine the correlations of these exposures to lifetime HCV infection among a targeted sample of 553 PWID in Los Angeles and San Francisco, California in 2016-18. Results: In multivariate logistic regression models, higher odds of blood on clothing in the last 30 days was significantly (p < 0.05) associated with lifetime positive HCV status, opioids as primary drug, injecting with others, sharing cookers, and receptive syringe sharing. Higher adjusted odds of blood on nearby surfaces in the last 30 days was significantly associated with lifetime positive HCV status, sharing cookers, and receptive syringe sharing. Native American race was associated with significantly lower adjusted odds of both outcome variables. Conclusions/Importance: Results indicate the relevance of physical and social micro-environments to the potential for blood exposures secondary to injection episodes. Individuals with chronic HCV seropositivity are potentially more likely to expose others to blood due to decreases in the blood’s ability to clot. This highlights the need for increased HCV testing at harm reduction sites and increased supply of first aid and wound-care materials to help stop potential blood exposures after injection episodes.

Research paper thumbnail of Assisted injection provider practices and motivations in Los Angeles and San Francisco California 2016–18

International Journal of Drug Policy, 2020

Protein kinase C signals thromboxane induced increases in fibronectin synthesis and TGF.p bioacti... more Protein kinase C signals thromboxane induced increases in fibronectin synthesis and TGF.p bioactivity in mesangial cells. Previous studies have demonstrated that thromboxane (TX) stimulates matrix protein synthesis in mesangial cells (MC), and that this action is signalled by receptor mediated activation of protein kinase C (PKC). In the present study, we examined the hypothesis that activation of PKC by TX signals increases in transforming growth factor /3 (TGF-/3) bioactivity, which in turn induces enhanced matrix protein synthesis. In cultured rat MC, the TXAJ prostaglandin endoperoxide analogue U-46619, but not exogenous human platelet TGF-/31, activated PKC as reflected by enhanced in situ phosphorylation of MARCKS protein, an endogenous substrate of PKC. U-46619 and TGF-/31 stimulated fibronectin (Fn) synthesis in MC, as shown by [35S]methionine incorporation into immunoprecipitable Fn. Pan-specific rabbit anti-TGF-f3 antibody blocked the increases in Fn synthesis induced by exogenous TGF-/3 and those induced by U-46619 at 24 to 72 hours after addition. Anti-TGF-/3 antibody did not block the small increases in Fn synthesis observed six hours after addition of U-46619, suggesting that this acute response was not dependent on TGF-/3. Anti-TGF-13 antibody also failed to block activation of PKC by U-46619. U-46619 and 50 n of the PKC agonist phorbol dibutyrate (PDBu) significantly increased both the active fraction and total (latent plus active) TGF-/3 in MC culture media, as assayed with the mink lung epithelial cell bioassay system. PKC inhibition with bisindolylmaleimide GF 109203X (GFX) or down-regulation of PKC in MC by prior exposure to a high concentration (0.5 j.tM) of phorbol myristate acetate (PMA) blocked increases in TGF-/3 bioactivity induced by either U-46619 or PDBu. PKC down-regulation in MC also blocked increases in Fn synthesis induced by U-46619. By contrast, exogenous TGF-/3 stimulated Fn synthesis in both intact MC and in MC with down-regulated PKC. The findings indicate that activation of PKC by U-46619 signals an increase in TGF-j3 bioactivity, which in turn stimulates Fn synthesis in MC by processes not dependent on PKC. examined the possibility that TX activation of PKC is a signal to increase TGF-/3 bioactivity in MC, which in turn mediates the sustained increases in Fn synthesis observed in response to TX. Methods Rat MC culture

Research paper thumbnail of Reasons for assisting with injection initiation: Results from a large survey of people who inject drugs in Los Angeles and San Francisco, California

Drug and Alcohol Dependence, 2020

Injection drug initiation usually requires assistance by someone who already injects drugs. To de... more Injection drug initiation usually requires assistance by someone who already injects drugs. To develop interventions that prevent people from starting to inject drugs, it is imperative to understand why people who inject drugs (PWID) assist with injection initiation. Methods: Injection initiation history and motives for initiating others were collected from 978 PWID in Los Angeles and San Francisco, CA, from 2016-17. This article documents motivations for providing injection initiation assistance and examines demographic, economic, and health-related factors associated with these motivations using multivariable logistic regression modeling. Results: Among the 405 PWID who ever facilitated injection initiation, motivations for initiating were: injury prevention (66%), skilled at injecting others (65%), to avoid being pestered (41%), in exchange for drugs/money (45%), and for food/shelter/transportation (15%). High frequency initiation (> 5 lifetime injection initiations) was associated with all motivations except for being pestered. Initiation to prevent injury was associated with being female. Initiation due to pestering was associated with recycling income and sex work. Being skilled was associated with age and HIV status, while initiation for money or drugs was associated with age, race, education, social security income, and substance use treatment. Lastly, initiation for food, shelter, or transportation was associated with age, sexual orientation and education level. Conclusion: Diverse factors were associated with reported motivations for assisting someone to initiate injection for the first time. Our analysis underscores the need for prevention strategies focused on improving economic and housing conditions along with implementing drug consumption rooms to disrupt the social processes of injection initiation.

Research paper thumbnail of Overdose Education and Naloxone Distribution Within Syringe Service Programs — United States, 2019

Morbidity and Mortality Weekly Report, Aug 21, 2020

Research paper thumbnail of Gang Involvement and Drug Use Histories Among People Who Inject Drugs in California: A Retrospective Analysis

Journal of Drug Issues, Jun 6, 2019

We examined whether gang membership history was associated with earlier age of first drug use, fi... more We examined whether gang membership history was associated with earlier age of first drug use, first drug injection, and shorter time to injection (TTI) drug use among people who inject drugs (PWID). PWID (N = 438) were interviewed in California (2011-2013). Surveys addressed demographics, current/former drug use practices, gang membership, and parental drug use. Multivariate analyses were conducted to identify whether gang membership history was associated with age at first drug use, first injection drug use, and TTI. Gang membership was reported by 23% of sample. Gang membership history was associated with earlier ages of first drug use (-1.35 years; 95% confidence interval [CI]= [−0.50, −2.20]), age at first injection (-1.89 years; 95% CI = [0.00, −3.78]), but not TTI. Gang involvement facilitates drug use including earlier age of first injection drug use.

Research paper thumbnail of Measures of harm reduction service provision for people who inject drugs

Bulletin of The World Health Organization, Jun 20, 2019

Measuring the effectiveness of needle and syringe programmes Daniel O'Keefe et al.

Research paper thumbnail of Individual-level needle and syringe coverage measurement as an international harm reduction planning and monitoring tool

Drug and Alcohol Review, Oct 31, 2019

Research paper thumbnail of Retailers' Perceptions of FDA Tobacco Regulation Authority

Tobacco regulatory science, May 1, 2019

Objectives:Research is limited on tobacco retailers’ perceptions of the Food and Drug Administrat... more Objectives:Research is limited on tobacco retailers’ perceptions of the Food and Drug Administration’s (FDA) tobacco regulatory authority overall, and less exists related to retailers in predominantly African-American or other racial/ethnic neighborhoods. We assessed differences in perceptions of the FDA’s tobacco regulatory authority and barriers to compliance among retailers in African-American and non-African-American neighborhoods in Los Angeles, California.Methods:Overall, 700 tobacco retailer interviews assessed demographic characteristics and perceptions of the FDA.Results:Retailers in African-American neighborhoods self-identified as Hispanic/Latino (43.9% vs 39.6% non-African-American), African-American (21.2% vs 2.6% non-African-American) or Asian (19.7% vs 19.5% non-African-American). Retailers in African-American neighborhoods were significantly less likely to perceive the FDA as a trustworthy source (p = .03; vs non-African-American), but more likely to report that they do not know the federal rules (p = .002), do not understand the federal rules (p = .004), and that tobacco companies encourage them not to follow the federal rules (p = .04).Conclusions:Tobacco control agencies can use this information about retailer perceptions to design education/training materials in order to increase trust, mitigate barriers, and enhance compliance.

Research paper thumbnail of Buprenorphine implementation at syringe service programs following waiver of the Ryan Haight Act in the United States

Drug and Alcohol Dependence, Aug 1, 2022

Research paper thumbnail of The naloxone delivery cascade: Identifying disparities in access to naloxone among people who inject drugs in Los Angeles and San Francisco, CA

Drug and Alcohol Dependence, Aug 1, 2021

BACKGROUND Opioid overdoses are a leading cause of injury death in the United States. Providing p... more BACKGROUND Opioid overdoses are a leading cause of injury death in the United States. Providing people who inject drugs (PWID) with naloxone is essential to preventing deaths. However, research regarding gaps in naloxone delivery is limited. METHODS We interviewed 536 PWID in San Francisco and Los Angeles, California from 2017 to 2018. We described naloxone engagement and re-engagement cascades, and identified factors associated with receiving naloxone in the past six months and currently owning naloxone. RESULTS The engagement cascade showed 72 % of PWID ever received naloxone, 49 % received it in the past six months, and 35 % currently owned naloxone. The re-engagement cascade showed, among PWID who received naloxone in the past six months, 74 % used and/or lost naloxone, and 67 % refilled naloxone. In multivariable analyses, identifying as Latinx (aRR = 0.53; 95 % CI: 0.39, 0.72) and Black (aRR = 0.73; 95 % CI: 0.57, 0.94) vs White were negatively associated with receiving naloxone in the past six months, while using opioids 1-29 times (aRR = 1.35; 95 % CI: 1.04, 1.75) and 30+ times (aRR = 1.52; 95 % CI: 1.17, 1.99) vs zero times in the past 30 days and witnessing an overdose in the past six months (aRR = 1.69; 95 % CI: 1.37, 2.08) were positively associated with receiving naloxone in the past six months. In multivariable analyses, being unhoused vs housed (aRR = 0.82; 95 % CI: 0.68, 0.99) was negatively associated with currently owning naloxone. CONCLUSIONS Our study adds to the literature by developing naloxone engagement and re-engagement cascades to identify disparities. Naloxone scale-up should engage populations facing inequitable access, including people of color and those experiencing homelessness.

Research paper thumbnail of Best practices for community-based overdose education and naloxone distribution programs: results from using the Delphi approach

Harm Reduction Journal, May 28, 2022

Background: Opioid-related overdose deaths have surged in the USA over the last two decades. Over... more Background: Opioid-related overdose deaths have surged in the USA over the last two decades. Overdose fatalities are preventable with the timely administration of naloxone. Syringe service programs (SSP) have pioneered community-based naloxone distribution through overdose prevention and naloxone distribution (OEND) programs. There is a dearth of information with regards to best practices for community-based OEND. Methods: We utilized a modified Delphi approach to develop a set of best practices for OEND delivery. Starting with an initial list of best practices, we engaged 27 experts, in the field of OEND programming who reviewed, made recommendations for changes, and assigned a priority to each best practice. Results: Two rounds of input resulted in a final list of 20 best practices organized into four categories. The mean priority scores ranged from 1.17 to 2.17 (range 1 to 3). The top 5 ranked best practices were ensuring that SSP participants have low barrier, consistent, needs-based access to naloxone and that there is ample naloxone available within communities. While the remaining fifteen best practices were deemed important, they had more to do with organizational culture and implementation climate. Conclusions: Increasing community-based OEND delivery is essential to reduce opioid overdose deaths; however, it will be insufficient to add programs without an eye toward quality of implementation and fidelity to the model upon which the evidence is based. This list of best practices summarizes the consensus among OEND experts and can serve as a tool for SSPs providing OEND programming to improve services.

Research paper thumbnail of Initiating Persons into Injection Drug Use in Rural West Virginia, USA

Substance Use & Misuse, Oct 8, 2019

Background: While prior research has explored factors associated with people who inject drugs (PW... more Background: While prior research has explored factors associated with people who inject drugs (PWID) initiating others into drug injection in urban settings, very little work has been done to understand this behavior among rural PWID in Appalachia. Objectives: We aim to identify factors associated with PWID initiating injection-naïve individuals into drug injection in a rural community in West Virginia (WV). Methods: Data were derived from a cross-sectional survey of 420 rural PWID (163 women) in Cabell County, WV in June-July 2018 who indicated recent (past 6 months) injection drug use. Individuals completed a survey that included measures on socio-demographics and injection socialization behaviors. We used logistic regression to identify factors associated with PWID recently initiating someone for their first injection.

Research paper thumbnail of Transition from injecting opioids to smoking fentanyl in San Francisco, California

Drug and Alcohol Dependence, Oct 1, 2021

BACKGROUND The introduction of illicitly made fentanyl in the United States has slowly replaced h... more BACKGROUND The introduction of illicitly made fentanyl in the United States has slowly replaced heroin. New illicit drugs are often associated with changes in frequency and modes of administration. We assessed changes in injection frequency and smoking fentanyl in the new era of fentanyl availability in San Francisco. METHODS We used targeted sampling to recruit 395 people who inject drugs (PWID) into an observational cohort study in San Francisco 2018-2020. We assessed changes in injection frequency, opioid injection frequency and fentanyl smoking frequency in four six-month periods. We also conducted qualitative interviews with PWID asking about motivations for injecting and smoking opioids. RESULTS The median number of past-month injections steadily decreased by semi-annual calendar year from 92 injections in July to December 2018 to 17 injections in January to June 2020. The rate of opioid injections reduced by half (Adjusted Incidence Rate Ratio = 0.41; 95 % Confidence Interval = 0.25, 0.70; p < 0.01). The number of days smoking fentanyl was associated with fewer number of injections (X2(2) = 11.0; p < 0.01). Qualitative interviews revealed that PWID's motivation for switching from injecting tar heroin to smoking fentanyl was related to difficulties accessing veins. After switching to smoking fentanyl, they noticed many benefits including how the drug felt, improved health, fewer financial constraints, and reduced stigma. CONCLUSION Between 2018 and 2020, there was a shift from injecting tar heroin to smoking fentanyl in San Francisco. Reductions in injection of illicit drugs may offer public health benefit if it reduces risk of blood-borne viruses, abscesses and soft-tissue infections, and infective endocarditis.

Research paper thumbnail of Refining a Multicomponent Intervention to Increase Perceived HIV Risk and PrEP Initiation: Focus Group Study Among Black Sexual Minority Men

JMIR Formative Research

Background Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decreas... more Background Increased preexposure prophylaxis (PrEP) initiation is needed to substantially decrease HIV incidence among Black sexual minority men (BSMM). However, BSMM perceive others as PrEP candidates instead of themselves and are less likely than other groups to use PrEP if prescribed. Peers and smartphone apps are popular HIV prevention intervention tools typically used independently. However, they could be useful together in a multicomponent strategy to improve perceived HIV risk and PrEP initiation for this group. Information regarding attitudes and preferences toward this multicomponent strategy is limited. Objective The goal of this study is to obtain attitudes and perspectives regarding the design of a multicomponent intervention that uses a smartphone app and a peer change agent (PCA) to increase perceived HIV risk and PrEP initiation. The intervention will be refined based on thematic findings for a culturally responsive approach. Methods Data were obtained guided by life ...

Research paper thumbnail of Assessing overdose education and naloxone distribution within syringe service programs throughout the United States" (IS01)

Addiction Science & Clinical Practice, Dec 30, 2020

Research paper thumbnail of Factors associated with methamphetamine withdrawal symptoms among people who inject drugs

Drug and Alcohol Dependence, 2021

BACKGROUND Regular methamphetamine (MA) use can result in withdrawal syndrome characterized by fa... more BACKGROUND Regular methamphetamine (MA) use can result in withdrawal syndrome characterized by fatigue, agitation, depression, and anxiety. No studies that we are aware of have examined the prevalence and predictors of MA withdrawal symptoms among people who inject drugs (PWID). METHODS PWID were recruited using targeted sampling methods in Los Angeles and San Francisco, California from 2016 to 2017. Survey questions included demographics, drug use, and MA withdrawal symptoms, frequency, and symptom severity. Participants who reported regular MA use (> 12 times in the last 30 days) were included in this analysis (N = 595). Multivariable regression models were developed to examine factors associated with any MA withdrawal, withdrawal frequency, symptom severity, and receptive syringe sharing. RESULTS MA withdrawal symptoms in the past 6 months were reported by 53 % of PWID, with 25 % reporting weekly withdrawal symptoms, and 20 % reporting very or extremely painful symptoms. In multivariable logistic regression, presence of any MA withdrawal symptoms was positively associated with more frequent MA use and non-injection tranquilizer use and inversely associated with crack cocaine use. Among those reporting any withdrawal, female sex was associated with more frequent withdrawal symptoms. Very or extremely painful withdrawal symptoms were associated with being in residential treatment. Receptive syringe sharing was associated with any MA withdrawal symptoms and weekly frequency of symptoms. CONCLUSION MA withdrawal symptoms are common among PWID and are associated with receptive syringe sharing. Strategies for implementing MA use treatment, safe supply programs, and syringe services programs targeting people who inject MA are indicated.

Research paper thumbnail of Prevalence and predictors of recent temporary psychiatric hold among a cohort of people who inject drugs in Los Angeles and San Francisco, California

Drug and Alcohol Dependence, 2021

California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH)... more California's Welfare and Institutions code 5150 allows for a temporary psychiatric hold (TPH) of individuals who present a danger to themselves or others and/or may be gravely disabled due to mental illness. Little is known about the frequency and predictors of involuntary holds among people who inject drugs (PWID). METHODS We sought to identify the prevalence and predictors of recent TPHs (within the past 12 months) among a community-recruited sample of PWID in Los Angeles and San Francisco, California during 2017-2018 (N = 531). Multivariable logistic regression modeling was used to evaluate demographic (e.g., age), economic (e.g., homelessness), drug use (e.g., types of drugs used), incarceration (e.g., recent arrest history) and mental health (e.g., lifetime mental health diagnosis) variables associated with recent TPH. RESULTS Age (40-49 years old vs age 50 or older: AOR = 5.85; 95 % CI = 2.18, 15.67), current homelessness (AOR = 3.75; 95 % CI = 1.28, 11.0), lifetime mental health history (AOR = 6.23; 95 % CI = 2.08, 18.66), and frequency of methamphetamine use (AOR = 1.01; 95 % CI = 1.00, 1.01) were statistically associated with increased odds of having experienced a TPH, while frequency of past month heroin/opioid use was associated with decreased odds of reporting a TPH (AOR = 0.99; 95 % CI = 0.99, 1.00) in multivariable analysis. CONCLUSIONS Diverse factors were associated with TPH among PWID. Our analysis underscores the need for research on PWID with co-occurring substance-use and mental illness disorders and homelessness. There is urgent need for expanding access to lower barrier publicly funded mental health treatment from a harm-reduction approach.

Research paper thumbnail of Small Randomized Controlled Trial of the New Passport to Wellness HIV Prevention Intervention for Black Men Who Have Sex With Men (BMSM)

AIDS Education and Prevention, 2020

We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve eng... more We developed and tested Passport to Wellness (PtW), a client-centered intervention to improve engagement in HIV/STI prevention and services to improve social determinants of health among Black men who have sex with men (BMSM) using incentives and peer support. We assessed PtW's impact on HIV/STI screening and pre/post-exposure prophylaxis (PrEP/PEP) knowledge/uptake using a randomized trial that compared the full intervention to one lacking peer support. We compared changes within groups surveyed at baseline and 6 months. We enrolled 80 eligible BMSM, among 399 screened. Among retained participants (34 peer-supported; 27 comparison), overall increases were observed in HIV (30% to 87% p < .001) and STI (28% to 80% p < .001) testing within the prior 6 months, as well as in PrEP and PEP awareness, and PrEP use. Statistically significant between group differences were not observed. Tailored prevention planning, incentives, and addressing social determinants may help move Black...

Research paper thumbnail of Initial Efficacy of a Community-Derived Mindfulness-Based Intervention for Latinx Parents and their Children

Journal of Immigrant and Minority Health, 2021

Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress... more Mindfulness-based interventions (MBIs) may offer a means for Latinx families to ameliorate stress, enhance emotion regulation, and foster social support. We assessed pilot data from Latinx parents in Eastside Los Angeles (n = 27) matched with their children aged 10–16 (n = 32) to determine whether participation in a community-derived MBI was associated with greater improvements in dispositional mindfulness, perceived stress, emotion regulation, and family social support compared to a control condition. Compared to the control group, parents in the MBI group showed greater reductions in perceived stress scale (PSS) scores (B = − 2.94, 95% CI [− 5.58, − 0.39], p = 0.029), while their children reported greater increases in perceived social support from family (B = 2.32, 95% CI [0.26, 4.38], p = 0.027). Findings show a community-derived MBI may improve stress in Latinx parents and social support for their children.

Research paper thumbnail of Factors associated with health-related cannabis use intentions among a community sample of people who inject drugs in Los Angeles and San Francisco, CA 2016 to 2018

Drug and Alcohol Dependence, 2021

Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensar... more Cannabis motivations have been studied extensively among patients of medicinal cannabis dispensaries, but less is known about motivations in community samples of opioid-using people who inject drugs. Our objective is to describe cannabis use motivations associated with self-treatment of physical pain, emotional issues, and as an opioid substitute. Methods: Data come from 6-month follow-up interviews with people who inject drugs who participated in a study on the efficacy of an injection initiation prevention intervention in Los Angeles and San Francisco, California from 2016− 18. The analytic sample consists of 387 people who inject drugs who reported past-month cannabis use. We developed multivariable logistic regression models by reported cannabis use motivations: physical pain relief, emotional problems, and opioid substitute. Results: The most common cannabis use motivations reported by people who inject drugs was to "get high," relieve physical pain and emotional problems, and reduce opioid use. In separate multivariate models, using cannabis for physical pain relief was associated with higher odds of using cannabis as a substitute for opioids; cannabis for emotional problems was associated with being diagnosed with depression; and cannabis as a substitute for opioids was associated with non-prescribed, non-injection methadone use. Conclusion: People who inject drugs reported using cannabis for health-related motivations. This motivation aligns with health needs and suggests the acceptability of cannabis use for health reasons in this population. Studies to determine the medical effectiveness of cannabis products for these common health and mental health needs among people who inject drugs are needed.

Research paper thumbnail of Novel Routes of Potential Hepatitis C Virus Transmission among People Who Inject Drugs: Secondary Blood Exposures Related to Injection Drug Use

Substance Use & Misuse, 2021

Abstract Background: The US is in the midst of a national Hepatitis C Virus (HCV) epidemic that a... more Abstract Background: The US is in the midst of a national Hepatitis C Virus (HCV) epidemic that appears to be driven by new cases among people who inject drugs (PWID). While HCV transmission among PWID is believed to occur mostly through direct sharing of syringes, some infections may be spread via secondary processes and materials involved in injecting. Objectives: Here, we present the prevalence of secondary blood exposures on clothing and nearby surfaces after injection episodes and examine the correlations of these exposures to lifetime HCV infection among a targeted sample of 553 PWID in Los Angeles and San Francisco, California in 2016-18. Results: In multivariate logistic regression models, higher odds of blood on clothing in the last 30 days was significantly (p < 0.05) associated with lifetime positive HCV status, opioids as primary drug, injecting with others, sharing cookers, and receptive syringe sharing. Higher adjusted odds of blood on nearby surfaces in the last 30 days was significantly associated with lifetime positive HCV status, sharing cookers, and receptive syringe sharing. Native American race was associated with significantly lower adjusted odds of both outcome variables. Conclusions/Importance: Results indicate the relevance of physical and social micro-environments to the potential for blood exposures secondary to injection episodes. Individuals with chronic HCV seropositivity are potentially more likely to expose others to blood due to decreases in the blood’s ability to clot. This highlights the need for increased HCV testing at harm reduction sites and increased supply of first aid and wound-care materials to help stop potential blood exposures after injection episodes.

Research paper thumbnail of Assisted injection provider practices and motivations in Los Angeles and San Francisco California 2016–18

International Journal of Drug Policy, 2020

Protein kinase C signals thromboxane induced increases in fibronectin synthesis and TGF.p bioacti... more Protein kinase C signals thromboxane induced increases in fibronectin synthesis and TGF.p bioactivity in mesangial cells. Previous studies have demonstrated that thromboxane (TX) stimulates matrix protein synthesis in mesangial cells (MC), and that this action is signalled by receptor mediated activation of protein kinase C (PKC). In the present study, we examined the hypothesis that activation of PKC by TX signals increases in transforming growth factor /3 (TGF-/3) bioactivity, which in turn induces enhanced matrix protein synthesis. In cultured rat MC, the TXAJ prostaglandin endoperoxide analogue U-46619, but not exogenous human platelet TGF-/31, activated PKC as reflected by enhanced in situ phosphorylation of MARCKS protein, an endogenous substrate of PKC. U-46619 and TGF-/31 stimulated fibronectin (Fn) synthesis in MC, as shown by [35S]methionine incorporation into immunoprecipitable Fn. Pan-specific rabbit anti-TGF-f3 antibody blocked the increases in Fn synthesis induced by exogenous TGF-/3 and those induced by U-46619 at 24 to 72 hours after addition. Anti-TGF-/3 antibody did not block the small increases in Fn synthesis observed six hours after addition of U-46619, suggesting that this acute response was not dependent on TGF-/3. Anti-TGF-13 antibody also failed to block activation of PKC by U-46619. U-46619 and 50 n of the PKC agonist phorbol dibutyrate (PDBu) significantly increased both the active fraction and total (latent plus active) TGF-/3 in MC culture media, as assayed with the mink lung epithelial cell bioassay system. PKC inhibition with bisindolylmaleimide GF 109203X (GFX) or down-regulation of PKC in MC by prior exposure to a high concentration (0.5 j.tM) of phorbol myristate acetate (PMA) blocked increases in TGF-/3 bioactivity induced by either U-46619 or PDBu. PKC down-regulation in MC also blocked increases in Fn synthesis induced by U-46619. By contrast, exogenous TGF-/3 stimulated Fn synthesis in both intact MC and in MC with down-regulated PKC. The findings indicate that activation of PKC by U-46619 signals an increase in TGF-j3 bioactivity, which in turn stimulates Fn synthesis in MC by processes not dependent on PKC. examined the possibility that TX activation of PKC is a signal to increase TGF-/3 bioactivity in MC, which in turn mediates the sustained increases in Fn synthesis observed in response to TX. Methods Rat MC culture

Research paper thumbnail of Reasons for assisting with injection initiation: Results from a large survey of people who inject drugs in Los Angeles and San Francisco, California

Drug and Alcohol Dependence, 2020

Injection drug initiation usually requires assistance by someone who already injects drugs. To de... more Injection drug initiation usually requires assistance by someone who already injects drugs. To develop interventions that prevent people from starting to inject drugs, it is imperative to understand why people who inject drugs (PWID) assist with injection initiation. Methods: Injection initiation history and motives for initiating others were collected from 978 PWID in Los Angeles and San Francisco, CA, from 2016-17. This article documents motivations for providing injection initiation assistance and examines demographic, economic, and health-related factors associated with these motivations using multivariable logistic regression modeling. Results: Among the 405 PWID who ever facilitated injection initiation, motivations for initiating were: injury prevention (66%), skilled at injecting others (65%), to avoid being pestered (41%), in exchange for drugs/money (45%), and for food/shelter/transportation (15%). High frequency initiation (> 5 lifetime injection initiations) was associated with all motivations except for being pestered. Initiation to prevent injury was associated with being female. Initiation due to pestering was associated with recycling income and sex work. Being skilled was associated with age and HIV status, while initiation for money or drugs was associated with age, race, education, social security income, and substance use treatment. Lastly, initiation for food, shelter, or transportation was associated with age, sexual orientation and education level. Conclusion: Diverse factors were associated with reported motivations for assisting someone to initiate injection for the first time. Our analysis underscores the need for prevention strategies focused on improving economic and housing conditions along with implementing drug consumption rooms to disrupt the social processes of injection initiation.