Drug Sharing Among Heroin Networks: Implications for HIV and Hepatitis B and C Prevention

Abstract

Qualitative and quantitative findings from the baseline survey of a longitudinal, socially-focused blood-borne disease intervention study among 611 heroin IDU in Denver indicate that high risk injection practices-the sharing of contaminated drug solution in particular-often occur as a consequence of how heroin is obtained, the quantity obtained and the setting where it is injected. Contamination occurs if a contaminated syringe is used to liquefy and apportion the shared drug. In our cohort of 304 heroin injecting networks there was at least one member who, when asked to describe their last injection, reported dividing the drug as a liquid (82%), using a reservoir of water that syringes had been rinsed in to mix drugs (67%), using a common cooker (86%)-a proxy for drug sharing-and beating a shared cotton filter (58%). In contrast, only 22% reported syringe sharing. Variables associated with various injection practices included location of the last injection episode, quantity of drug injected, dope sickness, and years injecting. When compared to those who injected in a safe setting, those in an unsafe location had almost three times the odds (OR = 2.9; 95% CI: 1.9, 4.6) of being part of an injection episode where there was cooker sharing; and the smaller the quantity of heroin (< or =1/4 gram v. > 1/4 gram) present at the episode, the greater the odds that cooker sharing occurred (OR = 1.8; 95% CI: 1.2, 2.6). Use of a used, unbleached syringe to prepare shared drugs had twice the odds of occurring in "unsafe" v. safe settings (OR = 2.2; 95% CI: 1.3, 4.0) and in episodes in which a participant was dopesick (OR = 2.1; 95% CI: 1.2, 3.6). In summary, risky injection practices occur within an injection process that is, in part, a response to a structurally imposed risk environment. Lessening the blood-borne disease risks embedded within this process requires interventions designed to mitigate the environmental factors that influence it, including syringe accessibility, law enforcement strategies and the settings where IDU inject drugs.

Syringe possession arrests are associated with receptive syringe sharing in two Mexico–US border cities

“…Injecting in public places has been associated with risky injection behaviors and HIV seroconversion in several studies [15,[35][36][37]]-a consequence of hurrying injection to minimize risk of police detection and arrest. This is a particularly common practice among homeless IDUs.…”

“…Overall, 92% were male and 99% considered themselves Hispanic or Latino. Median age was 34 years [interquartile range (IQR): [28][29][30][31][32][33][34][35][36][37][38][39][40] and median time since first injection was 12.5 years (IQR: [8][9][10][11][12][13][14][15][16][17][18][19].…”

Update and Overview of Practical Epidemiologic Aspects of HIV/AIDS among Injection Drug Users in the United States

“…Prevalence of Injecting Behaviors Varies The prevalence of syringe sharing varies by site from approximately 22 to 62% [41][42][43] and may be decreasing in some sites. 44 Sharing of drug solution and equipment may be more common than sharing of syringes.…”

Prevalence and correlates of prescription opioid residue injection

“…Injection of drug residues has been previously described among heroin users in the western United States, where black tar was the most prevalent form of heroin (Bourgois, 1998;Koester et al, 2005;Bourgois and Schonberg, 2009). Ethnographers observed that similar to some PO formulations, black tar heroin was not easily dissolvable and left significant amounts of residues in filters used for injection.…”

“…To date, only four studies have looked at the prevalence of drug residue injection, focusing on injecting someone else's drug residue (Koester et al, 2005;Evans et al, 2009;Le Marchand et al, 2013). To our knowledge, PO residue injection has never been measured or discussed explicitly in epidemiological studies.…”