High-risk behaviors associated with transition from illicit non-injection to injection drug use among adolescent and young adult drug users: a case-control study

Aim Better sterile syringe access should be associated with a lower likelihood of syringe re-use and receptive syringe sharing, although few empirical studies have examined gradients in syringe access using both individual and ecological data In this study, we compare syringe re-use and receptive syringe sharing among injection drug users (IDUs) with syringe exchange program (SEP) and legal over-the-counter pharmacy access with limits on syringes that can be purchased, exchanged or possessed to IDUs with no pharmacy sales but unlimited syringe access through SEPs We address three questions: (1) Does residing in an area with no legal syringe possession increase the likelihood of police contact related to possessing drug paraphernalia? (2) Among direct SEP users, is use of more permissive SEPs associated with less likelihood of syringe re-use and receptive syringe sharing? (3) Among non-SEP users, is residing in an area with pharmacy access associated with lower likelihood of syringe re-use and receptive syringe sharing?



Design  Quantitative survey of IDUs recruited from SEPs, subject nomination and outreach methods Multivariate analyses compared police contact, syringe re-use and receptive syringe sharing among IDUs recruited in three cities



Findings  In multivariate analyses, we found that police contact was associated independently with residing in the area with no legal possession of syringes; among SEP users, those with access to SEPs without limits had lower syringe re-use but not lower syringe sharing; and that among non-SEP users, no significant differences in injection risk were observed among IDUs with and without pharmacy access to syringes



Conclusion  We found that greater legal access to syringes, if accompanied by limits on the number of syringes that can be exchanged, purchased and possessed, may not have the intended impacts on injection-related infectious disease risk among IDUs

Sterile syringe access conditions and variations in HIV risk among drug injectors in three cities.

Objective To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. Design Pre–post comparison. Setting In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. Main Outcome Measures Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. Results Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% ( P ever pharmacy use increased: 4.9% to 12.5% ( P Conclusion To date, no evidence of harmful effects (discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.

/pdf/impact-of-increased-syringe-access-preliminary-findings-on-1h8elujnkv.pdf

Impact of Increased Syringe Access: Preliminary Findings on Injection Drug User Syringe Source, Disposal, and Pharmacy Sales in Harlem, New York

Objectives To assess associations between needle exchange program (NEP) use and drug injection risk practices. Methods Between 1997-2000, injecting drug users (IDUs) in Chicago were recruited from NEPs and an area with no NEP, interviewed about risk practices, and counseled and tested for HIV. The risk practices of "regular NEP users"--those who obtained at least half of their needles from an NEP (n = 558)--were compared with those of IDUs who did not use an NEP (n = 175). Results In multivariate analysis, regular NEP users, compared with NEP nonusers, were less likely to receptively share needles (adjusted odds ratio [AOR], 0.30; 95% CI, 0.19-0.46); lend used needles (AOR, 0.47; 95% CI, 0.31-0.71); share cookers (AOR, 0.39; 95% CI, 0.25-0.61), cottons (AOR, 0.48; 95% CI, 0.32-0.72), or water (AOR, 0.41; 95% CI, 0.27-0.63); or use a needle for >1 injection (0.15; 95% CI, 0.08-0.27). Among those who shared needles, regular NEP users were significantly more likely to do so for a smaller proportion of injections, with fewer partners and persons socially closer, and to have always bleached used needles before injecting. Conclusions Regular NEP use is associated with less frequent and lower risk HIV injection risk practices.

HIV risk practices among needle exchange users and nonusers in Chicago.

The present study evaluated the effects of psychiatric comorbidity on substance use disorder prevalence, HIV risk behavior, and other problem severity in male and female out-of-treatment injection drug users newly registered at a syringe exchange program. Participants (N = 338) were administered the Structured Clinical Interview for the DSM-IV, the Addiction Severity Index, and the Risk Assessment Battery, and classified into one of four diagnostic groups: (1) no antisocial personality disorder (APD) or Axis I psychiatric disorder (N = 162), (2) APD only (N = 74), (3) Axis I psychiatric disorder only (N = 55), or (4) APD plus Axis I psychiatric disorder (N = 47). Psychiatric comorbidity was associated with higher rates of substance use disorder and more HIV risk and other problem severity. In general, participants with both APD and an Axis I disorder exhibited the most problem severity. APD was uniquely associated with higher prevalence for each substance use disorder assessed in this study and with elevated HIV risk. These results support and extend studies conducted with opioid-dependent individuals recruited from treatment and community settings, and reinforce the need to develop interventions to encourage syringe exchange program participants to enroll in treatment.

Psychiatric comorbidity is associated with drug use and HIV risk in syringe exchange participants.

The objectives of this study were to describe characteristics and utilization patterns of participants attending a needle-exchange program (NEP) in Chicago, Illinois. Since 1994, demographics of NEP attendees and program utilization data were collected systematically at 22 sites operated by the Chicago Recovery Alliance (CRA). Descriptive statistics were used to assess time trends, site variations, and characteristics of attendees in day sites versus evening sites. A total of 11,855 injection drug users (IDUs) visited the NEP at least once from 1994 to 1998. Median age was 41 years, and 74% were male. Overall race distribution was African-American 50%, Caucasian 38%, Puerto Rican 10%, other 2%. Over time, there was a proportional decrease in African-American users (55.4% to 39.9%,P<.001), a significant increase in Puerto Rican users (1.4% to 14.1%,P<.001), and a stable proportion of Caucasian users (42%). Each year, 15–20% of all clients were first-time attenders. Overall, participants attending evening versus day sites were younger (median age 39 years vs. 42 years,P<.001) and more ethnically diverse. Over a 4-year period, this NEP reached a diverse population of IDUs and recruited a stable proportion of first-time users. Compared to daytime NEP venues, evening NEP sites attracted younger clients and those who were more diverse ethnically. To maximize coverage of sterile syringes, NEPs should strive for diversification in terms of hours of operation and location.

Characteristics and utilization patterns of needle-exchange attendees in Chicago: 1994-1998.

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Characteristics and utilization patterns of needle-exchange attendees in Chicago: 1994-1998.