Public drug use in eight U.S. cities: Health risks and other factors associated with place of drug use

Sutter, Alison; Curtis, Matt; Frost, Taeko

doi:10.1016/j.drugpo.2018.11.007

Cited by 25 publications

(18 citation statements)

References 55 publications

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“…Fear of assault and being discovered by the public or the police encourages rushed higher risk injections where PWID are less likely to follow safer injection practices ( Dovey, Fitzgerald & Choi, 2001 ; Small et al., 2007 ). These conditions increase the risk of fatal and non-fatal overdose, which has been consistently demonstrated in the literature ( Darke, Kaye & Ross, 2001 ; Hunter et al., 2018 ; Sutter, Curtis & Frost, 2019 ; Vallance et al., 2018 ; Wallace, Kennedy, Kerr & Pauly, 2019 ).…”

Section: Introductionmentioning

confidence: 59%

“…Though the relationship between public injecting and overdose has been well demonstrated, particularly in North America ( Hunter et al., 2018 ; Sutter et al., 2019 ; Vallance et al., 2018 ; Wallace et al., 2019 ), to the best of our knowledge this is the first study which has demonstrated an association between overdose and public injecting in the UK. This has important implications and suggests that public injecting may be contributing to Scotland's record levels of drug-related deaths (DRD) ( National Records of Scotland, 2019 ).…”

Section: Discussionmentioning

confidence: 84%

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Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

Trayner

McAuley

Palmateer

et al. 2020

International Journal of Drug Policy

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Background Whilst injecting drugs in public places is considered a proxy for high risk behaviour among people who inject drugs (PWID), studies quantifying its relationship with multiple drug-related harms are lacking and none have examined this in the context of an ongoing HIV outbreak (located in Glasgow, Scotland). We aimed to: 1) estimate the prevalence of public injecting in Scotland and associated risk factors; and 2) estimate the association between public injecting and HIV, current HCV, overdose, and skin and soft tissue infections (SSTI). Methods Cross-sectional, bio-behavioural survey (including dried blood spot testing to determine HIV and HCV infection) of 1469 current PWID (injected in last 6 months) recruited by independent interviewers from 139 harm reduction services across Scotland during 2017–18. Primary outcomes were: injecting in a public place (yes/no); HIV infection; current HCV infection; self-reported overdose in the last year (yes/no) and SSTI the last year (yes/no). Multi-variable logistic regression was used to determine factors associated with public injecting and to estimate the association between public injecting and drug-related harms (HIV, current HCV, overdose and SSTI). Results Prevalence of public injecting was 16% overall in Scotland and 47% in Glasgow city centre. Factors associated with increased odds of public injecting were: recruitment in Glasgow city centre (aOR=5.45, 95% CI 3.48–8.54, p <0.001), homelessness (aOR=3.68, 95% CI 2.61–5.19, p <0.001), high alcohol consumption (aOR=2.42, 95% CI 1.69–3.44, p <0.001), high injection frequency (≥4 per day) (aOR=3.16, 95% CI 1.93–5.18, p <0.001) and cocaine injecting (aOR=1.46, 95% CI 1.00 to 2.13, p = 0.046). Odds were lower for those receiving opiate substitution therapy (OST) (aOR=0.37, 95% CI 0.24 to 0.56, p <0.001) and older age (per year increase) (aOR=0.97, 95% CI 0.95 to 0.99, p = 0.013). Public injecting was associated with an increased risk of HIV infection (aOR=2.11, 95% CI 1.13–3.92, p = 0.019), current HCV infection (aOR=1.49, 95% CI 1.01–2.19, p = 0.043), overdose (aOR=1.59, 95% CI 1.27–2.01, p <0.001) and SSTI (aOR=1.42, 95% CI 1.17–1.73, p <0.001). Conclusions These findings highlight the need to address the additional harms observed among people who inject in public places and provide evidence to inform proposals in the UK and elsewhere to introduce facilities that offer safer drug consumption environments.

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Section: Introductionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 84%

Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

Trayner

McAuley

Palmateer

et al. 2020

International Journal of Drug Policy

View full text Add to dashboard Cite

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“…As observed in the current study and elsewhere, non-injectors appear to report lower interest in SCS/SIF [4], demonstrating the importance of targeted outreach and being attentive in messaging. Given the high co-occurrence of homelessness and reliance on public drug use settings among PWUD [25,31,32], settings with high levels of both conditions may also consider broader structural interventions such as Housing First programs, which have been shown to reduce alcohol use [33,34]. Fentanyl has substantially altered the overdose landscape in North America and in many settings worldwide.…”

Section: Discussionmentioning

confidence: 99%

Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston

et al. 2019

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Safe consumption spaces (SCS) are evidence-based interventions that reduce drug-related morbidity and mortality operating in many countries. However, SCS are yet to be widely implemented in the USA despite the escalating overdose epidemic. The aim of this multi-city study was to identify the factors associated with willingness to use a SCS among people who use drugs (PWUD) in Baltimore, Providence, and Boston, stratified by injection drug use status. Our secondary aim was to characterize the anticipated barriers to accessing SCS if they were to be implemented in these cities. PWUD were invited to complete a cross-sectional survey in 2017. The analysis was restricted to 326 opioid users (i.e., heroin, fentanyl, and non-medical opioid pill use). The majority (77%) of participants expressed willingness to use a SCS (Baltimore, 78%; Providence, 68%; Boston. 84%). Most respondents were male (59%), older than 35 years (76%), nonwhite (64%), relied on public/semi-public settings to inject (60%), had a history of overdose (64%), and recently suspected fentanyl contamination of their drugs (73%). A quarter (26%) preferred drugs containing fen-tanyl. Among injectors, female gender, racial minority status, suspicion of drugs containing fentanyl, and drug use in public/semi-public settings were associated with higher willingness to use a SCS; prior arrest was associated with lower willingness. Among non-injectors, racial minority status, preference for fentanyl, and drug use in public/semi-public settings were associated with higher willingness, whereas recent overdose held a negative association. The most commonly anticipated barriers to accessing a SCS in the future were concerns around arrest (38%), privacy (34%), confidentiality/ trust/safety (25%), and cost/time/transportation (16%). These data provide evidence of high SCS acceptability among high-risk PWUD in the USA, including those who prefer street fentanyl. As SCS are implemented in the USA, targeted engagement efforts may be required to reach individuals exposed to the criminal justice system.

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“…Risks for adverse health consequences associated with the modern opioid crisis are exacerbated by multiple structural vulnerabilities (e.g., homelessness, poverty, diminished access to HIV prevention services) that are highly prevalent among PWID populations, especially those residing in rural areas. Additionally, PWID that are structurally vulnerable may also engage in public drug use, which has been linked to several adverse outcomes, including overdose, syringe sharing, and discarded syringes [9–14]. As rural communities respond to the consequences of the opioid crisis, many have chosen to implement harm reduction programs to not only prevent overdose fatalities and infectious disease outbreaks, but also link PWID to drug treatment programs and other essential health and human services.…”

Section: Introductionmentioning

confidence: 99%

Acceptability of safe drug consumption spaces among people who inject drugs in rural West Virginia

et al. 2019

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Aim Safe consumption spaces (SCS) are indoor environments in which people can use drugs with trained personnel on site to provide overdose reversal and risk reduction services. SCS have been shown to reduce fatal overdoses, decrease public syringe disposal, and reduce public drug consumption. Existing SCS research in the USA has explored acceptability for the hypothetical use of SCS, but primarily among urban populations of people who inject drugs (PWID). Given the disproportionate impact of the opioid crisis in rural communities, this research examines hypothetical SCS acceptability among a rural sample of PWID in West Virginia. Methods Data were drawn from a 2018 cross-sectional survey of PWID ( n = 373) who reported injection drug use in the previous 6 months and residence in Cabell County, West Virginia. Participants were asked about their hypothetical use of a SCS with responses dichotomized into two groups, likely and unlikely SCS users. Chi-square and t tests were conducted to identify differences between likely and unlikely SCS users across demographic, substance use, and health measures. Results Survey participants were 59.5% male, 83.4% non-Hispanic White, and 79.1% reported likely hypothetical SCS use. Hypothetical SCS users were significantly ( p < .05) more likely to have recently (past 6 months) injected cocaine (38.3% vs. 25.7%), speedball (41.0% vs. 24.3%), and to report preferring drugs containing fentanyl (32.5% vs. 20.3%). Additionally, likely SCS users were significantly more likely to have recently experienced an overdose (46.8% vs. 32.4%), witnessed an overdose (78.3% vs. 60.8%), and received naloxone (51.2% vs. 37.8%). Likely SCS users were less likely to have borrowed a syringe from a friend (34.6% vs. 48.7%). Conclusions Rural PWID engaging in high-risk behaviors perceive SCS as an acceptable harm reduction strategy. SCS may be a viable option to reduce overdose fatalities in rural communities.

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Public drug use in eight U.S. cities: Health risks and other factors associated with place of drug use

Cited by 25 publications

References 55 publications

Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

Increased risk of HIV and other drug-related harms associated with injecting in public places: national bio-behavioural survey of people who inject drugs

Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston

Acceptability of safe drug consumption spaces among people who inject drugs in rural West Virginia

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