Ainslie J Butler1, Jürgen Rehm2, Benedikt Fischer3. 1. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario M5S 2S1, Canada. Electronic address: ainslie.butler@gmail.com. 2. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario M5S 2S1, Canada; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M5S, 1A1, Canada; Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Ontario M5S 1A1, Canada. Electronic address: jtrehm@gmail.com. 3. Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario M5S 2S1, Canada; Department of Psychiatry and Institute of Medical Science, University of Toronto, Toronto, Ontario M5S 1A1, Canada; Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Ontario M5S 1A1, Canada; Department of Psychiatry, Universidade Federal de Sao Paulo, Sao Paulo - SP, CEP: 04038-000, Brasil. Electronic address: benedikt.fischer@utoronto.ca.
Abstract
BACKGROUND: Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS: A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS: Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS: Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
BACKGROUND:Crack-cocaine use is prevalent largely in socio-economically marginalized populations in the Americas. Its use has been associated with diverse health outcomes, yet no recent or systematic reviews of these exist. METHODS: A systematic review of health outcomes associated with crack-cocaine use was performed, using MEDLINE, Scopus, Web of Science, CINAHL, PsycINFO, and LILACS up to October 2016. Search terms included crack-cocaine and health outcome-related keywords, targeting peer-reviewed studies on quantified health outcomes associated with crack-cocaine use. Random effects meta-analyses produced pooled odds ratios. Levels of evidence for major results were assessed using the GRADE approach. A review protocol was registered with PROSPERO (CRD42016035486). RESULTS: Of 4700 articles returned, 302 met eligibility criteria, reporting on health outcomes for 14 of 22 ICD-10 chapters. Conclusive evidence and meta-analyses showed positive associations between crack-cocaine use and blood/sexually transmitted diseases (HIV and hepatitis C virus, others); moderate evidence and meta-analyses supported associations with neonatal health, and violence. There were mixed associations for mental and other health outcomes, yet insufficient evidence to perform meta-analyses for many categories (e.g., mortality). Most underlying research was of limited or poor quality, with crack-cocaine commonly assessed as a secondary covariate. CONCLUSIONS:Crack-cocaine use was associated with a range of health outcomes, although it was unclear if there was direct causal impact, interactions between risk factors, or external drivers of both crack-cocaine use and outcomes. Rigorous epidemiological studies are needed to systematically assess health outcomes of crack-cocaine use and underlying pathways, also to inform evidence-based interventions.
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