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Open Access Publications from the University of California

Scholarly Works (49 results)

  • Article
  • Peer Reviewed
UC San Diego Previously Published Works (2015)
A large body of scientific evidence indicates that policies based solely on law enforcement without taking into account public health and human rights considerations increase the health risks of people who inject drugs (PWIDs) and their communities. Although formal laws are an important component of the legal environment supporting harm reduction, it is the enforcement of the law that affects PWIDs' behavior and attitudes most acutely. This commentary focuses primarily on drug policies and policing practices that increase PWIDs' risk of acquiring HIV and viral hepatitis, and avenues for intervention. Policy and legal reforms that promote public health over the criminalization of drug use and PWID are urgently needed. This should include alternative regulatory frameworks for illicit drug possession and use. Changing legal norms and improving law enforcement responses to drug-related harms requires partnerships that are broader than the necessary bridges between criminal justice and public health sectors. HIV prevention efforts must partner with wider initiatives that seek to improve police professionalism, accountability, and transparency and boost the rule of law. Public health and criminal justice professionals can work synergistically to shift the legal environment away from one that exacerbates HIV risks to one that promotes safe and healthy communities.
    • Thesis
    • Peer Reviewed
    UC San Diego Electronic Theses and Dissertations (2023)

    Purpose: Substance use is prevalent in U.S. criminal legal system (CLS) cases, yet court-ordered treatments rarely recommend effective treatments such as medications for addiction treatment (MAT). The stressful work coupled with lack of preparation among CLS professionals to support various pathways to recovery is theorized to drive and facilitate high rates of burnout, leading to stigma towards defendants with substance use disorder (DWSUD). This study aims to enhance our understanding of the connection between CLS occupational stress, substance use disorder (SUD) stigma, and to evaluate the impact of a tailored training on attitudes and practices concerning DWSUD within the CLS. Methodology: Using a mixed methods approach, we collected primary data. Qualitative data explored possible drivers, facilitators, and practices of substance use-related stigma among CLS professionals. We utilized various national trainings to collect pre-post-training survey data. Pre-training data assessed the relationship of burnout and attitudes towards DWSUD. Pre-post-training data assessed changes in behavioral intentions to refer to MAT for SUD-related cases, intentions to engage in self-care for managing occupational stress, and attitudes toward DWSUD. Findings: CLS professionals experience complex and intense occupational stress, leading to manifestations of emotional, mental, and physical symptoms; driving and facilitating SUD stigma. There was a significant relationship between 2 of the 3 occupational burnout dimensions and attitudes towards DWSUD. The adapted SHIELD training significantly improved attitudes and behavioral intentions related to SUD cases and promoting well-being behaviors among CLS professionals. Implications: These results highlight the urgent need for targeted interventions that provide resources increasing efficacy regarding SUD-related cases and addressing the demanding and stress-inducing nature of CLS professionals' work, as occupational stress contributes to SUD stigma. The adapted SHIELD training demonstrates the positive impact intervention has on attitudes and behavioral intentions, ultimately promoting well-being within the CLS profession. By identifying the nuanced relationships between burnout dimensions and attitudes, as well as the impact of an adapted training intervention, the study contributes valuable insights into improving the well-being of CLS professionals and promoting fair treatment for individuals with SUD. The study's findings advocate for enhanced curriculum, intervention strategies, and more resources to create a more empathetic and effective legal environment.

      • Peer Reviewed
      UC Davis Previously Published Works (2020)
      Paper presented at Proceedings 1992 Annual Conference American Holistic Veterinary Medical Association
        Cover page: Ethical and Legal Considerations
        • Thesis
        • Peer Reviewed
        UC San Diego Electronic Theses and Dissertations (2017)

        This research seeks to evaluate the impact of drug policy reform in Mexico within the larger Latin American context. Through theoretical and statistical analyses, I use the case study of the municipal Police Department in Tijuana to understand the implementation of Mexico’s 2009 “narcomenudeo” drug policy reform that decriminalized drug possession for personal consumption. Using internal unpublished police data, I demonstrate that the policy shift did not appear to impact the policing of drug arrests over the five years following the implementation of the reform. Police education efforts designed to improve officer understanding of the reform and its street-level implementation found low baseline knowledge of the decriminalization policy, shedding light into the mechanisms impeding its application. Training evaluation suggested that officers increased their legal knowledge, but that training uptake was shaped by level of educational attainment. Ultimately, these findings add to the emerging implementation science literature on the importance of structural interventions to better align public health-oriented drug policy reforms with their intended impact in Latin America and elsewhere.

          Cover page: Evaluating the Implementation of Drug Decriminalization in Tijuana Mexico: Police and Public Health
          • Article
          • Peer Reviewed
          UC San Diego Previously Published Works (2016)

          Aims

          In the context of a public health-oriented drug policy reform in Mexico, we assessed the spatial distribution of police encounters among people who inject drugs (PWID) in Tijuana, determined the association between these encounters and the location of addiction treatment centers and explored the association between police encounters and treatment access.

          Design

          Geographically weighted regression (GWR) and logistic regression analysis using prospective spatial data from a community-recruited cohort of PWID in Tijuana and official geographical arrest data from the Tijuana Municipal Police Department.

          Setting

          Tijuana, Mexico.

          Participants

          A total of 608 participants (median age 37; 28.4% female) in the prospective Proyecto El Cuete cohort study recruited between January and December 2011.

          Measurements

          We compared the mean distance of police encounters and a randomly distributed set of events to treatment centers. GWR was undertaken to model the spatial relationship between police interactions and treatment centers. Logistic regression analysis was used to investigate factors associated with reporting police interactions.

          Findings

          During the study period, 27.5% of police encounters occurred within 500 m of treatment centers. The GWR model suggested spatial correlation between encounters and treatment centers (global R(2)  = 0.53). Reporting a need for addiction treatment was associated with reporting arrest and police assault [adjusted odds ratio = 2.74, 95% confidence interval (CI) = 1.25-6.02, P = 0.012].

          Conclusions

          A geospatial analysis suggests that, in Mexico, people who inject drugs are at greater risk of being a victim of police violence if they consider themselves in need of addiction treatment, and their interactions with police appear to be more frequent around treatment centers.
            • Article
            • Peer Reviewed
            UCLA Previously Published Works (2021)
            As overdose mortality is spiking during the COVID-19 pandemic, few race/ethnicity-stratified trends are available. This is of particular concern as overdose mortality was increasing most rapidly in Black and Latinx communities prior to the pandemic. We used quarterly, age-standardized overdose mortality rates from California to assess trends by race/ethnicity and drug involved over time. Rates from 2020 Q2-Q4 were compared to expected trends based on ARIMA forecasting models fit using data from 2006 to 2020 Q1. In 2020 Q2-Q4 overdose death rates rose by 49.8% from 2019, exceeding an expected increase of 11.5% (95%CI: 0.5%-22.5%). Rates significantly exceeded forecasted trends for all racial/ethnic groups. Black/African American individuals saw an increase of 52.4% from 2019, compared to 42.6% among their White counterparts. The absolute Black-White overdose mortality gap rose from 0.7 higher per 100,000 for Black individuals in 2018 to 4.8 in 2019, and further increased to 9.9 during the pandemic. Black overdose mortality in California was therefore 34.3% higher than that of White individuals in 2020 Q2-Q4. This reflects growing methamphetamine-, cocaine-, and fentanyl-involved deaths among Black communities. Growing racial disparities in overdose must be understood in the context of the unequal social and economic fallout from the COVID-19 pandemic, during which time Black communities have been subjected to the dual burden of disproportionate COVID-19 deaths and rising overdose mortality. Increased investments are required to ameliorate racial/ethnic disparities in substance use treatment, harm reduction, and the structural drivers of overdose, as part of the COVID-19 response and post-pandemic recovery efforts.
              Cover page: Growing racial/ethnic disparities in overdose mortality before and during the COVID-19 pandemic in California
              • Article
              • Peer Reviewed
              UC San Diego Previously Published Works (2014)
                • Article
                • Peer Reviewed
                UC San Diego Previously Published Works (2022)
                Between 2015 and 2018, we provided training for 1806 municipal police officers in Tijuana, Mexico, in an effort to improve their knowledge and behaviors related to HIV and injection drug use. Correct knowledge of syringe possession laws improved from 56% before training to 94% after training and was sustained at 24 months (75%). Knowledge improvement was associated with decreases in arrests for syringe possession over time (adjusted odds ratio [AOR] = 0.87; 95% confidence interval [CI] = 0.85, 0.90). Officers with correct knowledge had significantly lower odds of reporting arrests (AOR = 0.63; 95% CI = 0.44, 0.89). Training was associated with sustained improvements in knowledge and practices that advance public health. (Am J Public Health. 2022;112(6):860-864. https://doi.org/10.2105/AJPH.2021.306702).
                  • Article
                  • Peer Reviewed
                  UC San Diego Previously Published Works (2018)
                  AIM:To assess the effect of involuntary drug treatment (IDT) on non-fatal overdose among people who inject drugs (PWID). DESIGN:Longitudinal study. SETTING:Tijuana, Mexico. PARTICIPANTS:Baseline sample of 671 PWID included 258 (38.4%) women and 413 (61.6%) men. MEASUREMENTS:Primary independent variables were reported recent (i.e. past 6 months) non-fatal overdose event (dependent variable) and IDT. Substance use the day of the non-fatal overdose was also examined. FINDINGS:From 2011 to 2017, 213 participants (31.7%) reported a recent non-fatal overdose and 103 (15.4%) reported recent IDT. Heroin, in combination with methamphetamine and tranquilizers, were the drugs most reported at the day of the event. IDT significantly increased the odds of reporting a non-fatal overdose event [adjusted odds ratio (aOR) = 1.76; 95% confidence interval (CI) = 1.04-2.96]. Odds of non-fatal overdose also increased independently for each additional injection per day (aOR = 1.05; 95% CI = 1.02-1.08), recent tranquilizer use (aOR = 1.92; 95% CI = 1.41-2.61) and using hit doctors (aOR = 1.68; 95% CI = 1.29-2.18) and decreased with age (aOR = 0.97 per year, 95% CI = 0.95-0.99). CONCLUSIONS:Recent involuntary drug treatment in Mexico is a risk factor for non-fatal drug overdose.
                    • Article
                    • Peer Reviewed
                    UC San Francisco Previously Published Works (2020)

                    Background

                    Opioid overdose mortality continues to increase in the United States despite significant investments to reverse the epidemic. The national response to-date has focused primarily on reducing opioid prescribing, yet reductions in prescribing have been associated with patients reporting uncontrolled pain, psychological distress, and transition to illicit substances. The aim of this study is to qualitatively explore chronic pain management experiences among PLWH with a history of illicit substance use after long-term opioid therapy reductions or discontinuations.

                    Methods

                    We analyzed 18 interviews, stopping upon reaching thematic saturation, with HIV-positive participants with a history of substance use who were enrolled in a longitudinal cohort study to assess the impact of prescribing changes among patients with chronic pain. Participants in this nested qualitative study had been reduced/discontinued from opioid pain relievers (OPRs) within the 12 months prior to interview. Interviews were audio-recorded and transcribed verbatim. Two analysts coded all interviews, interrater reliability was measured, and coding discrepancies discussed. The study took place in San Francisco, California in 2018.

                    Results

                    Eleven participants were male with a mean age of 55; 8 were African American and 8 were White. All participants were HIV-positive, actively engaged in primary care, and had a lifetime history of illicit substance use. Twelve reported using illicit substances within the past year, including non-prescription opioids/heroin (10), and stimulant use (10). After being reduced/discontinued from their long-term opioid therapy, patients reported developing complex multimodal pain management systems that often included both nonpharmacological approaches and illicit substance use. Participants encountered a range of barriers to nonpharmacological therapies including issues related to accessibility and availability. Participants often reported attempts to replicate their prior OPR prescription by seeking out the same medication and dose from illicit sources and reported transitioning to heroin after exhausting other options.

                    Conclusion

                    After being reduced/discontinued from OPRs, HIV-positive patients with a history of substance use reported experimenting with a range of pain management modalities including nonpharmacological therapies and illicit substance use to manage symptoms of opioid withdrawal and pain. Providers should consider that any change to a patients' long-term opioid therapy may result in experimentation with pain management outside of the medical setting and may want to employ patient-centered, holistic approaches when managing patients' opioid prescriptions and chronic pain.
                      Cover page: “Chasing the pain relief, not the high”: Experiences managing pain after opioid reductions among patients with HIV and a history of substance use
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