Werb D, Wagner K D, Beletsky L, Gonzalez-Zuniga Patricia, Rangel Gudelia, Strathdee S A
Division of Global Public Health, Department of Medicine, University of California, San Diego, United States; BC Centre for Excellence in HIV/AIDS, Vancouver, Canada.
Division of Global Public Health, Department of Medicine, University of California, San Diego, United States.
Drug Alcohol Depend. 2015 Mar 1;148:221-5. doi: 10.1016/j.drugalcdep.2015.01.011. Epub 2015 Jan 20.
In 2009, Mexico passed legislation to decriminalize drug possession and improve access to addiction treatment. We undertook research to assess the implementation of the reform among a cohort of people who inject drugs (PWID) in Tijuana. This study specifically sought to determine whether discretionary policing practices like extortion impact access to methadone maintenance therapy (MMT) in Tijuana, a city characterized by high levels of drug-related harms.
Generalized estimating equation analyses were used to construct longitudinal confounding models to determine the association between paying a police bribe and MMT enrolment among PWID in Tijuana enrolled in a prospective cohort study. Outcome of interest was MMT enrolment in the past six months. Data on police interactions and MMT enrolment were also obtained.
Between October, 2011 and September, 2013, 637 participants provided 1825 observations, with 143 (7.8%) reports of MMT enrolment during the study period. In a final confounding model, recently reporting being forced to pay a bribe to police was significantly associated with an increased likelihood of accessing MMT (adjusted odds ratio=1.69, 95% confidence interval: 1.02-2.81, p=0.043). However, in 56 (39.2%) cases, MMT enrolment ceased within six months. The majority of participant responses cited the fact that MMT was too expensive (69.1%).
Levels of MMT access were low. PWID who experienced police extortion were more likely to access MMT at baseline, though this association decreased during the study period. Coupled with the costs of MMT, this may compromise MMT retention among PWID.
2009年，墨西哥通过立法将持有毒品合法化，并改善成瘾治疗的可及性。我们开展研究，以评估在蒂华纳的一组注射吸毒者（PWID）中该改革的实施情况。本研究特别旨在确定诸如敲诈勒索等任意执法行为是否会影响蒂华纳（一个毒品相关危害程度高的城市）美沙酮维持治疗（MMT）的可及性。
采用广义估计方程分析构建纵向混杂模型，以确定在一项前瞻性队列研究中登记的蒂华纳PWID中支付警察贿赂与MMT登记之间的关联。感兴趣的结果是过去六个月内MMT登记情况。还获取了关于与警方互动和MMT登记的数据。
2011年10月至2013年9月期间，637名参与者提供了1825份观察结果，其中143人（7.8%）报告在研究期间登记接受MMT。在最终的混杂模型中，最近报告被迫向警察行贿与获得MMT的可能性增加显著相关（调整后的优势比=1.69，95%置信区间：1.02 - 2.81，p = 0.043）。然而，在56例（39.2%）病例中，MMT登记在六个月内停止。大多数参与者的回答指出MMT费用太高（69.1%）。
MMT的可及水平较低。经历过警察敲诈勒索的PWID在基线时更有可能接受MMT，尽管这种关联在研究期间有所下降。再加上MMT的费用，这可能会影响PWID对MMT的持续接受。
