Individual and Environmental Factors Related to Quitting Heroin Injection

Abstract

This study examines the relationship between individual-level and the certain neighborhood characteristics with drug use cessation among a sample of long-term inner-city heroin injectors in Baltimore, Maryland. The data were derived from baseline and first follow-up visits of SHIELD, a larger HIV prevention intervention study targeting members of the drug-using community. The survey instrument was interviewer-administered and ascertained sociodemographics, drug use history, and sexual and drug risk behaviors. The data were collected between August 1997 and March 1999. The current study was limited to participants with a median age of 41 years old. 27.5% (n=53) reported quitting drug use at follow-up. Compared with those who quit, participants who continued (n=147) were close to five times as likely to buy drugs in the neighborhoods in which they lived, 80% less likely to have used drugs in a shooting gallery in the past 6 months, and close to five times more likely to have used drugs in outside places. Controlling for other factors, enrollment in drug user treatment programs or attending self-help groups were not significantly associated with drug use cessation. This study points to the importance of examining specific environmental factors in relation to quitting drug use. Research is needed to further articulate the types and characteristics of physical environments that are related to and could be intervened in promoting sustainable drug cessation.

Experiencing Violence as a Predictor of Drug Use Relapse among Former Drug Users in Baltimore, Maryland

“…Place of residence influences exposure to drugs and violence and potential vulnerability to long-term drug use. 28 Studies have shown that neighborhood drug access 29 and social network drug influences 30 can present substantial challenges to drug cessation. In this sample, involvement in the drug economy was not associated with relapse.…”

The association between neighborhood residential rehabilitation and injection drug use in Baltimore, Maryland, 2000–2011

“…This assumption could be incorrect if exposure to other neighborhoods has more influence on drug abuse. However, research in Baltimore has demonstrated that purchasing drugs in one's neighborhood, and living in a neighborhood with considerable drug market activity, are associated with persistent injection drug use [69] and a higher likelihood of positive illicit drug tests among probationers [70]. Another potential limitation of using neighborhoods is that residential rehabilitation may be more heterogeneous at the neighborhood level than at smaller geographies (e.g.…”

Application of Space-Time Scan Statistics to Describe Geographic and Temporal Clustering of Visible Drug Activity

“…10 Perceived opportunities to use illicit drugs have been associated with urges to use illicit drugs 22 and social norms supportive of use. 23 Through such pathways, visible drug activity may encourage illicit drug use.…”

“…[5][6][7] Visible drug market activity bears negative implications upon residents living in proximity by glorifying risk behaviors to youth, stigmatizing and marginalizing communities, 5 and serving as a potential determinant of violence, 8 sexually transmitted diseases, 9 and drug abuse. 10,11 Baltimore City is among several US cities where visible drug market activity occurs in some communities and has been associated with economic deprivation, poor housing stock, and social disorder. [12][13][14] Visible drug market activity has been reported as being concentrated in East and West Baltimore, 15 but these regions greatly influence illicit drug use beyond their borders.…”