Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs.

Jarlais, Don C. Des; Paone, Denise; Friedman, Samuel R.; Peyser, Nina P.; Newman, Robert G.

doi:10.2105/ajph.85.11.1577

Cited by 85 publications

(60 citation statements)

References 19 publications

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“…This suggests that the relationship between arrest and syringe sharing documented in this study indicates a direct relationship between police practices and risky injection practices. Burris & Strathdee also posit that police could have an indirect effect on HIV risk, for example by discouraging IDUs' utilization of syringe exchange programs [28] or displacing IDUs to areas with limited or no access to syringe exchange programs or drug treatment [28,31]. Recent observational evidence from our study site in Tijuana suggests that displacement of homeless IDUs due to heightened police activity may also be contributing indirectly to risky injection practices.…”

Section: Discussionmentioning

confidence: 83%

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

Pollini

Brouwer

Lozada³

et al. 2007

Addiction

121

113

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Aims To identify factors associated with receptive syringe sharing among injection drug users (IDUs) and elucidate the association between syringe possession arrests and syringe sharing.Design Cross‐sectional study.Setting Mexican border cities of Tijuana, Baja California and Ciudad Juarez, Chihuahua.Participants IDUs in Tijuana (n = 222) and Ciudad Juarez (n = 206) were recruited using respondent‐driven sampling (RDS). IDUs were ≥ 18 years and had injected illicit drugs in the past month.Measurements An interviewer‐administered survey was used to collect quantitative data on socio‐demographic, behavioral and contextual characteristics, including self‐reported syringe sharing and arrests for syringe possession. Associations with receptive syringe sharing were investigated using logistic regression with RDS adjustment.Findings Overall, 48% of participants reported ever being arrested for carrying an unused/sterile syringe, even though syringe purchase and possession is legal in Mexico. Arrest for possessing unused/sterile syringes was associated independently with receptive syringe sharing [adjusted odds ratio (AOR) = 2.05; 95% confidence interval (CI): 1.26, 3.35], as was injecting in a shooting gallery (AOR = 3.60; 95% CI: 2.21, 5.87), injecting in the street (AOR = 2.05; 95% CI: 1.18, 3.54) and injecting methamphetamine (AOR = 2.77; 95% CI: 1.41, 5.47) or cocaine (AOR = 1.96; 95% CI: 1.15, 3.36). More than half of participants (57%) had been arrested for possessing a used syringe; in a second model, arrest for used syringe possession was also associated independently with receptive sharing (AOR = 2.87; 95% CI: 1.76, 4.69).Conclusions We documented high levels of syringe‐related arrests in two Mexican–US border cities and an independent association between these arrests and risky injection practices. Public health collaborations with law enforcement to modify the risk environment in which drug use occurs are essential to facilitate safer injection practices.

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Section: Discussionmentioning

confidence: 83%

“…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].…”

Section: Study Populationmentioning

confidence: 99%

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

Pollini

Brouwer

Lozada³

et al. 2007

Addiction

121

113

View full text Add to dashboard Cite

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“…These rules require the drug to be dispensed daily from a specially licensed clinic and sometimes limit the duration of treatment or the dose. 9,86,87 Public funds are not sufficient to treat all who require treatment, 88 and many injection drug users who pay privately for methadone maintenance discontinue for financial reasons. 89 Even if regulatory and financial barriers to methadone maintenance were reduced or eliminated, many injection drug users still would not enter treatment.…”

Section: Discussionmentioning

confidence: 99%

HIV transmission and the cost-effectiveness of methadone maintenance

Zaric¹,

Barnett²,

Brandeau³

2000

Am J Public Health

197

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OBJECTIVES: This study determined the cost-effectiveness of expanding methadone maintenance treatment for heroin addiction, particularly its effect on the HIV epidemic. METHODS: We developed a dynamic epidemic model to study the effects of increased methadone maintenance capacity on health care costs and survival, measured as quality-adjusted life-years (QALYs). We considered communities with HIV prevalence among injection drug users of 5% and 40%. RESULTS: Additional methadone maintenance capacity costs $8200 per QALY gained in the high-prevalence community and $10,900 per QALY gained in the low-prevalence community. More than half of the benefits are gained by individuals who do not inject drugs. Even if the benefits realized by treated and untreated injection drug users are ignored, methadone maintenance expansion costs between $14,100 and $15,200 per QALY gained. Additional capacity remains cost-effective even if it is twice as expensive and half as effective as current methadone maintenance slots. CONCLUSIONS: Expansion of methadone maintenance is cost-effective on the basis of commonly accepted criteria for medical interventions. Barriers to methadone maintenance deny injection drug users access to a cost-effective intervention that generates significant health benefits for the general population.

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“…Des Jarlais et al (1995) work in five cities where both low HIV prevalence and incidence remained low among IDUs over a minimum of six years suggest three factors contributed to "public health control" over HIV transmission among IDUs: (1) beginning prevention efforts when prevalence was still low; (2) using community outreach to establish trusted communication between health workers and drug users; and (3) providing a ready supply of sterile injection equipment.…”

Section: The Relevance Of Structural Constraints In Idu-related Hiv Vmentioning

confidence: 99%

Placing the dynamics of syringe exchange programs in the United States

Tempalski

2007

Health & Place

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Drawing upon the broader health, social, and political geography literature this paper outlines a framework for considering place-based processes through which syringe exchange availability may be understood. It is argued that the geographic distribution of syringe exchange programs (SEPs) in the United States is linked to the social and political conditions of particular localities through three place characteristics: (1) structural constraints; (2) social and spatial distancing of injection drug users; and (3) localized action. Although SEPs remain a controversial issue and face ongoing obstacles from the government, law enforcement and local communities, they continue to operate through the efforts of grassroots organizations and local activists. Action on this issue occurs locally, and the characteristics of place-based factors will affect whether particular areas adopt SEPs.

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Regulating controversial programs for unpopular people: methadone maintenance and syringe exchange programs.

Cited by 85 publications

References 19 publications

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

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

HIV transmission and the cost-effectiveness of methadone maintenance

Placing the dynamics of syringe exchange programs in the United States

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