TY  - JOUR
PY  - 2019//
TI  - Drugs, discipline and death: causes and predictors of mortality among people who inject drugs in Tijuana, 2011-2018
JO  - International journal on drug policy
A1  - West, Brooke S.
A1  - Abramovitz, Daniela A.
A1  - Gonzalez-Zuniga, Patricia
A1  - Rangel, Gudelia
A1  - Werb, Dan
A1  - Cepeda, Javier
A1  - Beletsky, Leo
A1  - Strathdee, Steffanie A.
SP  - e102601
EP  - e102601
VL  - 75
IS  - 
N2  - BACKGROUND: People who inject drugs (PWID) experience multiple risk factors for mortality; yet, we know little about causes of death among PWID in Tijuana, Mexico, an area with high levels of injecting and changes in policy/law enforcement responses to substance use. This study examines rates, causes, and predictors of mortality among Tijuana PWID. <br><br>METHODS: Data come from a community-based cohort of PWID aged ≥18 who injected drugs in the past month. Mortality was confirmed by death certificate over 78 months during 2011-2018. Predictors of mortality were identified using time-updated Cox regression, controlling for age. <br><br>RESULTS: Among 734 participants, there were 130 deaths (54 confirmed, 76 unconfirmed), with an incidence rate of 17.74 deaths per 1000 person-years for confirmed deaths (95% Confidence Interval (CI)=13.01, 22.48) and 39.52 for unconfirmed deaths (CI=32.72, 46.31). Confirmed deaths resulted from homicide/trauma (26%), overdose (26%), septic shock (18%) and HIV-related causes (9%). In multivariable analysis of confirmed deaths, baseline HIV seropositivity (adjusted Hazard Ratio [aHR]=6.77, CI=1.98, 23.17), incident HIV infection (aHR=3.19, CI=1.02, 9.96), and number of times being beaten by police in the past 6 months at baseline (aHR=1.08 per time, CI=1.04, 1.12) were predictive of death; whereas, injection cessation for 6+ months during time at risk (aHR=0.25, CI=0.33, 0.79) was protective. <br><br>CONCLUSION: In addition to overdose and HIV prevention efforts, attention to structural conditions that potentiate mortality is needed, including improved access to medication-assisted treatment to support injection cessation and a shift from police as a source of harm to harm reduction.<br><br>Copyright © 2019 Elsevier B.V. All rights reserved.<p />  <p>Language: en</p>
LA  - en
SN  - 0955-3959
UR  - http://dx.doi.org/10.1016/j.drugpo.2019.11.009
ID  - ref1
ER  -