Injections and infections: understanding syringe service program utilization in a rural state

Kinna Thakarar,Debra Burris,Kimberly Murray,Nitysari Sankar,Robert P Smith,Frances L Lucas

doi:10.1186/s12954-021-00524-1

Abstract

BackgroundIncreasing rates of injection drug use (IDU) associated-infections suggest significant syringe service program (SSP) underutilization. Our study objective was to assess practices of safe injection techniques and to determine predictors of SSP utilization in a rural state.Patients and methodsThis was a fifteen-month cross-sectional study of participants hospitalized with IDU-associated infections in Maine. Data were collected through Audio Computer-Assisted Self-Interview survey and medical record review. Descriptive analyses were performed to characterize demographics, health characteristics, and injection practices. The primary outcome was SSP utilization, and the main independent variable was self-reported distance to SSP. Logistic regression analyses were performed to identify factors associated SSP utilization, controlling for gender, homelessness, history of overdose, having a primary care physician and distance to SSP.ResultsOf the 101 study participants, 65 participants (64%) reported past 3 month SSP utilization, though only 33% used SSPs frequently. Many participants (57%) lived more than 10 miles from an SSP. Participants who lived less than 10 miles of an SSP were more likely to use an SSP (adjusted odds ratio 5.4; 95% CI 1.9–15.7).ConclusionsOur study highlights unsafe injection practices and lack of frequent SSP utilization among people admitted with IDU-associated infections in a rural state. Especially given increasing stimulant use, these results also highlight the need for SSP access. Particularly in rural areas where patients may live more than 10 miles from an SSP, expansion of harm reduction services, including mobile units, should be a priority.

Highlights

The increasing prevalence of substance use disorders in the United States has highlighted the need to examine approaches to reduce injection drug use (IDU)-associated infections [24]
Participants who lived less than 10 miles of an syringe service program (SSP) were more likely to use an SSP
Our study highlights unsafe injection practices and lack of frequent SSP utilization among people admitted with IDU-associated infections in a rural state

Summary

Introduction

The increasing prevalence of substance use disorders in the United States has highlighted the need to examine approaches to reduce injection drug use (IDU)-associated infections [24]. Outbreaks of HIV and viral hepatitis, such as those in Scott County, Indiana, and the rise of other serious complications such as infective endocarditis, have raised concern about access to preventive and treatment services for PWID in rural areas [5, 14, 15, 33] Some factors such as drug availability, close social networks, and economic hardship may play role in the increasing incidence of IDU-associated infections in rural areas [12]. Our study objectives were to (1) examine practices around safe injection techniques and (2) determine factors predicting utilization of SSPs. Increasing rates of injection drug use (IDU) associated-infections suggest significant syringe service program (SSP) underutilization. Our study objective was to assess practices of safe injection techniques and to determine predictors of SSP utilization in a rural state

Objectives

Methods

Results

Discussion

Conclusion