? As a junior faculty member at the University of California, San Francisco, Daniel Ciccarone, MD, MPH, has begun exploring the medical consequences of the use of black tar heroin. Through mentoring relationships, course work, structured tutorials and development of a research program, Dr. Ciccarone will advance his independence in conducting patient-oriented clinical research. ? ? The consequences of heroin use have long been documented. However, little attention has been given to the medical consequences of the specific type of heroin used. Heroin exists in two major morphologies in the United States. Black tar heroin (BTH), the form of heroin that predominates in the Western U.S., has been associated with soft tissue infections including abscesses, necrotizing fasciitis and various clostridial infections. BTH use may also account for the lower HIV prevalence among IDUs in the Western U.S. Behavioral patterns and health outcomes associated with the use of specific heroin types deserves further exploration. ? ? Study sites will include San Francisco, California and Hartford, Connecticut. Ethnographic study of street-based injection drug users (IDUs) will examine injection related behaviors including drug acquisition, storage, preparation, use and hygiene. Indigenous beliefs related to disease and specific heroin use will be explored. A survey instrument will be developed using results from the ethnographic study, current literature and expert opinion and will examine prevalence of disease outcomes and predictors of those outcomes. The survey will be administered to IDUs in the two cities, which differ on the predominant type of heroin available. ? ? The three goals of this study are: 1) To examine the behaviors and belief systems related to use of specific types of heroin with particular attention to issues of risk and hygiene; 2) To examine the health related outcomes of specific heroin use; and 3) To determine the independent effects of specific types of heroin on health outcomes, i.e., soft tissue infection, HIV and heroin related overdose. ? ? ? ?

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Human Development Research Subcommittee (NIDA)
Program Officer
Khalsa, Jagjitsingh H
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University of California San Francisco
Family Medicine
Schools of Medicine
San Francisco
United States
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Ciccarone, Daniel; Bourgois, Philippe (2016) Injecting drugs in tight spaces: HIV, cocaine and collinearity in the Downtown Eastside, Vancouver, Canada. Int J Drug Policy 33:36-43
Ciccarone, Daniel (2011) Stimulant abuse: pharmacology, cocaine, methamphetamine, treatment, attempts at pharmacotherapy. Prim Care 38:41-58
Ciccarone, Daniel (2009) Heroin in brown, black and white: structural factors and medical consequences in the US heroin market. Int J Drug Policy 20:277-82
Ciccarone, Daniel; Unick, George J; Kraus, Allison (2009) Impact of South American heroin on the US heroin market 1993-2004. Int J Drug Policy 20:392-401
Gilbert, Paul; Ciccarone, Daniel; Gansky, Stuart A et al. (2008) Interactive ""Video Doctor"" counseling reduces drug and sexual risk behaviors among HIV-positive patients in diverse outpatient settings. PLoS One 3:e1988
Bourgois, Philippe (2008) The mystery of marijuana: science and the U.S. War on Drugs. Subst Use Misuse 43:581-3
Hoffman, Ari; Utley, Brynn; Ciccarone, Dan (2008) Improving medical student communication skills through improvisational theatre. Med Educ 42:537-8
Ciccarone, Dan; Jain, Sharad; Bourgois, Philippe (2008) Understanding illicit substance use in the real world. Med Educ 42:532
Cooper, Hannah L F; Brady, Joanne E; Ciccarone, Daniel et al. (2007) Nationwide increase in the number of hospitalizations for illicit injection drug use-related infective endocarditis. Clin Infect Dis 45:1200-3
Bourgois, Philippe; Martinez, Alexis; Kral, Alex et al. (2006) Reinterpreting ethnic patterns among white and African American men who inject heroin: a social science of medicine approach. PLoS Med 3:e452

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