Psychological Distress Increases Needle Sharing among Cocaine users: Results from the COSMO Study

Abstract

Objective: Cocaine use and mental health disorders have both been separately identified as risk factors for blood borne virus infection. However, the contribution of specific underlying aspects of mental health to risks is not well documented. The aim of this study was to examine the association between psychological distress and risk behaviors for HIV and Hepatitis C infection among cocaine users.Methods: Individuals who either smoked or injected cocaine were recruited in community-based and addiction treatment programs located in downtown Montreal. Participants were asked to complete an interviewer-administered questionnaire assessing psychological distress based on the Kessler scale (K10). Three-month risk behaviors outcomes included drug injection material sharing (needle, dilution water, cooker, filters, backloading, frontloading or wash), and smoking equipment sharing. Socio-demographic data, severity of cocaine dependence and other substances use information were also collected. Statistical analyses were conducted using logistic regression.Results: Severe psychological distress was reported by 202 (34.3%) out of 589 participants (86.2% male; 76.6% ≥ 30y.o.). The prevalence of sharing was: 14.8% for needles, 24.9% for other injection equipment (378 injectors) and 68.3% for smoking material (508 smokers). Multivariate analysis showed that injectors with severe psychological distress were more likely to report needle sharing (Adjusted Odds Ratio (AOR): 2.1, 95% CI: 1.1-3.8). No significant association was found between K10 score and sharing of other paraphernalia. Conclusion:Severe psychological distress increases the risk of needle sharing, a major risk factor for HIV and HCV infection, but not sharing of other paraphernalia. These results suggest differential psychological mechanisms according to sharing practices. They also support the importance of screening for psychological distress in order to implement adequate preventive interventions aimed at cocaine users.

Understanding experiences of and rationales for sharing crack-smoking equipment: A qualitative study with persons who smoke crack in Montréal

“…These results are consistent with those in the quantitative study we conducted as part of the COSMO research project. In that study, analyses showed that severe psychological distress increased the odds of needle sharing but not of crack pipe sharing (Lévesque et al, 2014). However, participants' discourse suggested that in some cases, anxiety or desperation can influence sharing behaviours.…”

Tranquilizer misuse among active cocaine users: Predictors of initiation

“…The methodology used for the COSMO project was described in detail elsewhere . Briefly, to be eligible, participants must have used cocaine in the last month, either by smoking crack or by injection.…”

Prevalence and correlates of prescription opioid residue injection

“…The methodology was described in detail elsewhere (Lévesque et al, 2014). Briefly, to be eligible for the COSMO study, participants had to have used cocaine in the last month, either by smoking crack or by injection.…”