Public health efforts in preventing HIV and related diseases with injection drug users require clear understandings of the risk environment of drug consumption. One important aspect of the risk environment is drug supply. Specifically, the supply of heroin into the United States is changing dramatically: Over the past twenty years, heroin prices have decreased nationwide to record levels as purity has increased. This has occurred during the same time period as the number of heroin source regions has been reduced from 4 to 2. Heroin use is associated with significant social and medical problems. HIV and other blood-borne infections, e.g., hepatitis C, are still major concerns, but there is also rising concern about non-HIV heroin related medical consequences, e.g., heroin related overdose (HOD), soft tissue and other bacterial infections (BSTI), including abscess, cellulitis, necrotizing fasciitis and various clostridial infections, and endocarditis. The two US sources of heroin produce chemically distinct forms which maybe perceived/used differently. The two major heroin morphologies, "Black tar" heroin (BTH) and powdered heroin (PH) have preliminary associations with specific diseases. BTH is suggestively associated with soft tissue infections, while PH is ecologically correlated with HIV. These two forms have distinct geographic markets with BTH predominating in the western US and PH in the eastern US. Notably, preliminary research has shown significant ecological correlation between HIV prevalence among heroin injectors in western and eastern US cities and regional differences in the distribution of BTH and PH. Very little research has been done that analyzes the distinctive health problems associated with the different types of heroin and relates these differences to patterns of use. The purpose of this study is to illuminate the medical consequences particular to the two major types of heroin commonly found in the United States and relate them to changes in availability, price, purity and differing use patterns for these drugs. The specific objectives of this research project are: 1. To examine the trends in heroin related medical outcomes, e.g., HOD, BSTI, in up to 29 US metropolitan areas (MSAs), between 1990-2006, by changes in local heroin price and purity. 2. To examine the associations between the distribution of specific types of heroin (i.e., BTH and PH) and heroin related outcomes, e.g., HIV, HOD, and BSTI, in 20 US MSAs, controlling for confounding variables. 3. To assess the behaviors and belief systems of heroin users related to their use of specific types of heroin, in two cities;each with an exemplar heroin type. The Heroin Price, Purity and Outcomes (HPPO) study proposes a mixed methods approach.
Specific Aims 1 and 2 will be achieved by combining governmental databases on heroin economic data with multiple national databases on medical outcomes, analyzed using advanced statistical techniques.
Specific Aim 3 will involve two forms of qualitative inquiry: ethnographic assessment and in-depth qualitative interviews.

Public Health Relevance

Achieving the objectives of the Heroin Price, Purity and Outcomes (HPPO) study will enable improved public health surveillance and provide better behavioral and social risk understandings for use in epidemiological studies, as well as in tailored interventions to aid in preventing heroin related medical consequences.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA027599-03
Application #
8220788
Study Section
Behavioral and Social Science Approaches to Preventing HIV/AIDS Study Section (BSPH)
Program Officer
Deeds, Bethany
Project Start
2010-03-15
Project End
2015-01-31
Budget Start
2012-02-01
Budget End
2013-01-31
Support Year
3
Fiscal Year
2012
Total Cost
$357,285
Indirect Cost
$100,912
Name
University of California San Francisco
Department
Family Medicine
Type
Schools of Medicine
DUNS #
094878337
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Hansen, Helena; Bourgois, Philippe; Drucker, Ernest (2014) Pathologizing poverty: new forms of diagnosis, disability, and structural stigma under welfare reform. Soc Sci Med 103:76-83
Karandinos, George; Hart, Laurie Kain; Castrillo, Fernando Montero et al. (2014) The Moral Economy of Violence in the US Inner City. Curr Anthropol 55:1-22
Mars, Sarah G; Bourgois, Philippe; Karandinos, George et al. (2014) "Every 'never' I ever said came true": transitions from opioid pills to heroin injecting. Int J Drug Policy 25:257-66
Unick, George; Rosenblum, Daniel; Mars, Sarah et al. (2014) The relationship between US heroin market dynamics and heroin-related overdose, 1992-2008. Addiction 109:1889-98
Rosenblum, Daniel; Castrillo, Fernando Montero; Bourgois, Philippe et al. (2014) Urban segregation and the US heroin market: a quantitative model of anthropological hypotheses from an inner-city drug market. Int J Drug Policy 25:543-55
Rosenblum, Daniel; Unick, George Jay; Ciccarone, Daniel (2014) The entry of Colombian-sourced heroin into the US market: the relationship between competition, price, and purity. Int J Drug Policy 25:88-95
Unick, George Jay; Rosenblum, Daniel; Mars, Sarah et al. (2013) Intertwined epidemics: national demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993-2009. PLoS One 8:e54496
Ciccarone, Dan (2013) Saying goodbye to high-dead-space syringes. Int J Drug Policy 24:15-6
Messac, Luke; Ciccarone, Dan; Draine, Jeffrey et al. (2013) The good-enough science-and-politics of anthropological collaboration with evidence-based clinical research: Four ethnographic case studies. Soc Sci Med 99:176-86
Roy, Elise; Arruda, Nelson; Bourgois, Phillipe (2011) The growing popularity of prescription opioid injection in downtown Montreal: new challenges for harm reduction. Subst Use Misuse 46:1142-50

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