Needle Exchange Research Articles

Likelihood of using a harm reduction vending machine among rural people who inject drugs in Appalachian Kentucky.

Harm reduction vending machines (HRVMs) that dispense safe injection equipment and other supplies have operated globally for more than 30 years, yet few operate in the U.S., particularly in the rural epicenters of drug-related harms. This study explores likelihood of using HRVMs and correlates thereto among people who inject drugs in rural Appalachian Kentucky. Respondent-driven sampling and outreach were used to recruit participants who were age 18 or older, resided in an Appalachian Kentucky county, and had used opioids and/or injected drugs to get high in the past 30 days. Interviewer-administered questionnaires elicited data on behavioral and demographic characteristics and likelihood of using HRVMs. Analyses were restricted to participants who injected in the past 6 months (n = 259). Generalized estimating equations were used to estimate adjusted prevalence ratios (APRs) for correlates to likelihood of using HRVMs, controlling for lifetime use of brick-and-mortar syringe service programs. Overall, 57 % reported being likely to use HRVMs. Participants who lacked consistent access to transportation, engaged in receptive and distributive syringe sharing, experienced more lifetime overdoses, and had unsuccessfully attempted to access medications for opioid use disorder (MOUD) reported being more likely to use HRVMs. Heroin and prescription opioid use were negatively associated with likelihood of HRVM use, as was experience of shame around drug use. Most people who inject drugs in this rural Appalachian sample were likely to use HRVMs, with interest being highest among those at highest risk for injection-related infections and overdose and who had faced difficulty accessing MOUD.

Estimating the Cost-Saving Threshold of a Rural Syringe Services Program Before and During the COVID-19 Pandemic.

This study aimed to examine shifts in the cost-savings threshold of a rural syringe services program (SSP) that resulted in the 12-months following the identification of the COVID-19 pandemic. We compared SSP operational costs during the 12-months immediately before and after identification of the COVID-19 pandemic using administrative data from the Cabell-Huntington Harm Reduction Program (CHHRP), which is operated by the Cabell-Huntington Health Department in West Virginia. Data included monthly counts of client encounters, sterile syringe distribution, and HIV testing. Cost-savings threshold analyses were conducted to estimate the number of HIV infections that would have to be averted for the CHHRP to be cost-saving in the 12-months before and after the identification of the COVID-19 pandemic. In the 12-months following identification of the COVID-19 pandemic, there was a 13.6% reduction in the number of client encounters and a 69.3% reduction in the number of HIV tests administered at the CHHRP. From the healthcare perspective, in the 12-months before and after the pandemic, the CHHRP cost $190,151 and $116,727, respectively. The number of averted HIV infections required for the CHHRP to be cost-saving was less than one across both time periods and for all estimates of lifetime HIV-related medical costs. There were shifts in the operational costs at the CHHRP after the identification of the COVID-19 pandemic; however, the costs of providing harm reduction services were significantly less than lifetime HIV treatment costs for a single person. Increasing investments in harm reduction is essential for eliminating HIV transmission.

Expanded Naloxone Distribution by Opioid Overdose Prevention Programs to High-Need Populations and Neighborhoods in New York City.

From 2014 to 2017, the drug overdose death rate per 100,000 in New York City (NYC) increased by 81%, with 57% of overdoses in 2017 involving the opioid fentanyl. In response, overdose education and naloxone dispensing (OEND) efforts were expanded in NYC, informed by neighborhood-level and population-level opioid overdose fatality rates. We describe the demographic and geographical distribution of naloxone by NYC opioid overdose prevention programs (OOPPs; the primary distributor of naloxone to laypersons in NYC) as OEND was expanded in NYC. We developed and examined a measure of high-need naloxone distribution defined by OEND in a high-priority neighborhood, to a high-need population, or from a high-priority OOPP (i.e., syringe services programs, criminal legal-related programs, programs for unhoused people, substance use disorder treatment programs, etc.). We reported recipient-level naloxone dispensing data by OOPP type from April 2018 to March 2019 using descriptive statistics and age-adjusted population rates. We conducted univariable logistic regression analyses to identify predictors of naloxone receipt by race/ethnicity. Of the 69,333 naloxone recipients, 97.3% met our definition for high-need naloxone dispensing, with 55.8% residing in one of 13 high-priority neighborhoods. Naloxone receipt by race/ethnicity varied by OOPP type. Program goals to expand naloxone distribution to high-need populations were met. We observed racial/ethnic differences in receipt of naloxone by program type, which supports using a variety of OOPP program types to reach racially diverse populations.

HIV Prevention in Syringe Service Programs Since the Start of COVID-19: Where Do We Go From Here?

This narrative review addresses post-2020, specific, complex challenges for use of and adherence to pre-exposure prophylaxis (PrEP) for HIV prevention among out-of-treatment people who use drugs (PWUD) at syringe services programs (SSPs). The COVID-19 pandemic and its associated changes to the provision of healthcare have significantly impacted HIV prevention, especially for PWUD. Through a synthesis of literature and clinical experience, we (1) characterize the operational changes imposed by the pandemic on SSPs that shaped the current HIV prevention landscape; (2) describe three levels of current challenges for PWUD, including consumer attitudes, non-medical and medical provider attitudes, and structural and scalability barriers; (3) characterize current models for PrEP in SSPs; and (4) offer practical recommendations for HIV prevention in harm reduction programs. PrEP is a highly effective prevention tool if taken as prescribed. It has been enthusiastically promoted by members of the research, public health and provider communities. Despite its efficacy, PWUD struggle to engage with the PrEP care continuum. We highlight opportunities to advance HIV prevention for PWUD by enhancing tailored, whole-person approaches that may set aside PrEP in favor of other risk reduction routes. For most PWUD who receive services at SSPs, PrEP is a single tool and not realistic until other social and structural determinants of health are addressed.

An exploration of desired abstinent and non-abstinent recovery outcomes among people who use methamphetamine

BackgroundIn the United States, complete abstinence persists as the standard for demonstrating recovery success from substance use disorders (SUDs), apart from alcohol use disorder (AUD). Although the FDA has recently indicated openness for non-abstinence outcomes as treatment targets, the traditional benchmark of complete abstinence for new medications to treat SUDs remains a hurdle and overshadows other non-abstinent outcomes desired by people with SUDs (e.g., improved sleep, employment, family reunification). This study sought to expand the definition of recovery to include non-abstinent pathways by exploring non-abstinence-based outcomes desired by people who use methamphetamine (PWUM).MethodsParticipants (n = 100) were recruited from existing National Institute on Drug Abuse (NIDA) projects including a treatment-seeking sample of people recently released from prison (all of whom endorsed recent methamphetamine use) and a sample of people using syringe service programs. In a convergent survey design, participants responded to closed-ended questions regarding recovery outcomes, followed by open-ended items to gain a better understanding of PWUM and their conception of recovery. The importance of non-abstinent outcomes was measured in five categories (substance use, physical health, cognitive functioning, mental health, and financial/social/relationships).ResultsParticipants were primarily White (88%), male (67%), and an average age of 40. Approximately two-thirds of participants agreed that people need to stop all mood- or mind-altering substances to be in recovery (64%). Nevertheless, participants indicated a variety of desired non-abstinent recovery outcomes, both substance-related (e.g. reductions in methamphetamine use) and non-substance-related (e.g. improved economic stability). Specific non-abstinent outcomes endorsed as “absolutely essential” by PWUM included: preventing legal trouble (92%), employment stability (82%), improved quality of life (80%), housing stability (78%), improved coping skills (78%), improved relationships (75%), economic/income stability (74%), ability to think clearly (73%), less impulsivity (73%), less depression (71%), less stress (70%), improved hopefulness (70%), and improved sleep (70%). Open-ended responses emphasized employment stability, economic/income stability, improved coping skills, improved relationships, as well as improved energy, appetite, and sleep.ConclusionOur findings indicate the importance of non-abstinent recovery outcomes among PWUM, suggesting high acceptability of non-abstinent recovery targets by people with lived experience. Further, the essential importance of non-abstinent outcomes, especially in the financial/social/relationship and mental health domains, were highlighted, providing novel targets for delivering SUD treatment/recovery.

Long-Acting Injectable Prep for People Who Inject Drugs at a Syringe Services Program: A Qualitative Acceptability and Feasibility Study.

Although people who inject drugs (PWID) are at high risk of acquiring HIV, knowledge and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention among this population remain low due to numerous psychosocial and structural barriers. Multiple implementation strategies have been proposed to address this gap, notably providing long-acting injectable (LAI) formulations of PrEP and offering PrEP at syringe services programs (SSPs). This qualitative study explores the acceptability and feasibility of offering LAI-PrEP for PWID at risk for HIV at Florida's first legal SSP. In-depth semi-structured interviews were conducted with PWID (n = 25) and healthcare providers (n = 5), and transcripts were analyzed using iterative thematic analysis. The provision of LAI-PrEP at the SSP was overwhelmingly acceptable to both PWID and providers, and specific advantages and disadvantages of LAI-PrEP compared to oral PrEP among this population were elucidated. Likewise, PWID and providers identified facilitators and barriers to offering LAI-PrEP at the SSP and proposed recommendations for implementation. Overall, this study adds to the growing evidence that provision of LAI-PrEP at SSPs is acceptable and feasible and holds promise in expanding access to and uptake of HIV prevention services among PWID.

"It always needs a higher level of care than what I can provide": Practical, ethical, and administrative tensions arising from the integration of wound care services into syringe service programs in Maryland.

The emergence of xylazine into the U.S. drug supply has increased demand for wound care services among people who inject drugs (PWID). Traditional health care settings have historically been ill-equipped to accommodate the complex needs of PWID and syringe service programs (SSPs) have created wound care services to fill the gap. In doing so, many SSPs are extending the scope of their services beyond health promotion into a quasi-medical space that is largely unregulated. We conducted 10 qualitative interviews with staff employed by eight SSP programs across six counties in the state of Maryland to explore how they have navigated shifting demand for more intensive wound care services. Contested boundaries in training of non-medical staff, lack of clarity in SSP-based providers' scope of practice, and conflicts in operational norms and standards between harm reduction and medical services are significant sources of tension that impact delivery of wound care services in SSP settings. In taking on responsibility to provide wound care services to PWID, SSPs take on significant administrative, practical, and ethical burden that increase vulnerability to medicolegal liability. There is a significant unmet need for increased resources, administrative support, and mentorship to guide the integration of medicalized wound care into SSP programs. Additionally, efforts to expand access to community-based wound care services for PWID should not replace efforts to promote timely access to services in more traditional healthcare settings.

The prevalence of fentanyl in New York City’s unregulated drug supply as measured through drug checking offered at syringe service programs

The prevalence of fentanyl in New York City’s unregulated drug supply as measured through drug checking offered at syringe service programs

“New Normal:” Opportunities and Challenges Faced by Syringe Service Programs Following the Effects of the COVID-19 Pandemic

Background Syringe services programs (SSPs) provide critical evidence-based public health services that decrease harms from drug use for people who use drugs (PWUD). Many SSPs have experienced significant and evolving COVID-19-related disruptions. We aimed to characterize the impacts of COVID-19 on SSP operations in the United States approximately two years into the pandemic. Methods Participating sites, selected from a national sample of SSPs, completed a semi-structured interview via teleconference and brief electronic survey evaluating the impacts of COVID-19 on program operations. Data collection explored program financing, service delivery approaches, and perspectives on staff morale two years into the pandemic. Interview data were analyzed qualitatively using Rapid Assessment Process. Survey data were analyzed using descriptive statistics and triangulated with qualitative findings. Results Twenty-five SSPs completed the interview and survey between April – June 2022. Triangulation of qualitative and quantitative data characterized the dynamic ways that demand for SSP services has evolved throughout the pandemic, and how approaches to care delivery have increased in flexibility and participant-centeredness. However, SSPs expressed worry about longer-term barriers to program participant and staff engagement, and a mismatch between available programmatic resources and the “new normal” of service delivery needs. Conclusion The COVID-19 pandemic has had lasting impacts on multiple facets of syringe service delivery. While SSPs consistently meet barriers with ingenuity, greater programmatic and staff support is needed to ensure SSPs can continue to meet the changing public health needs for PWUD.

The effects of message framing on US police chiefs’ support for interventions for opioid use disorder: a randomized survey experiment

BackgroundUS chiefs of police hold significant influence over the perceived acceptability and appropriateness of interventions for opioid use disorder (OUD) among the public, elected officials, and subordinate officers. This study assessed whether police chiefs’ support for such interventions was sensitive to framing an intervention’s benefits in terms that emphasize public health and harm reduction outcomes, versus terms typically indicative of public safety outcomes.MethodsA two-armed survey utilizing a randomized, between-subjects design tested framing-based variance in support among US chiefs of police for overdose prevention centers, syringe service programs (SSPs), Good Samaritan laws, police naloxone distribution, trustworthiness of officers in recovery from OUD, and related propositions. Of 1,200 invitations, 276 chiefs participated (23%). The two experimental arms (n = 133, n = 143) were demographically balanced between both each other and non-respondents.ResultsChiefs were more likely to agree that their mission was protecting public safety than protecting public health, even when both were defined using public health outcomes. Chiefs expressed significantly greater support for “overdose prevention sites” than “safe injection sites” (p = .018), low levels of support for SSPs regardless of framing (18% safety; 19% health), and comparably more support for Good Samaritan laws based on framing (62% safety vs. 54% health). Respondents voiced low levels of trust in officers recovering from OUD generally (31%), and significantly lower levels of trust when recovery involved the medication buprenorphine (10%; p < .001). Senior chiefs were significantly more likely to support SSPs (aOR 1.05; CI 1.01, 1.09) and overdose prevention sites (aOR 2.45; CI 1.13, 5.28) than less senior chiefs.ConclusionsIn this cross-sectional survey experiment, support for some interventions for OUD was greater among US chiefs of police when framed to emphasize positive public safety outcomes. Research is required to better understand low support for SSPs, mistrust of officers in recovery for OUD, and greater support for OUD interventions among senior chiefs.

Would provision of Take Home Naloxone Kits by Emergency Medical Services be perceived as acceptable to people at risk of opioid overdose? A qualitative study

ABSTRACT OBJECTIVES Take home naloxone kits can reduce mortality, but we know little about how they are perceived by people with lived experience of opioid use. Provision of naloxone in the community has been shown to significantly reduce mortality from opioid overdose. Currently, this is predominantly through drug treatment support services but expanding provision through other services might be effective in increasing kit take-up and mortality reduction. This study aimed to examine participants' experiences of opiate overdose and acceptability of provision of naloxone kits through ambulance/paramedic emergency services (EMS) and hospital Emergency Departments (ED). METHODS Qualitative interviews were conducted with 26 people who had direct experience of opioid use. Participants were recruited at two substance-use treatment centres and a third sector support organisation in three large cities in the United Kingdom. Interviews examined respondents’ experiences of opioid use and opioid overdose, access and personal use of naloxone kits, and opinions about kit provision from EMS and hospital ED staff. Interview data were thematically analysed using a constant comparative method. RESULTS Four key themes were identified during analysis: 1) High levels of overdose experience and knowledge of naloxone and naloxone kits; 2) naloxone kits were perceived as effective and easy to use 3) There were some concerns around the risks of administering naloxone, such as peer aggression during withdrawal. 4) Participants supported much wider personal, family and peer provision of naloxone kits from community support organisations as well as from EMS. CONCLUSIONS Participants felt naloxone kits were an important resource and they wanted increased provision across a range of services including EMS and hospital ED staff as well as community pharmacies and needle exchange centres. Participants wanted naloxone kit provision to be extended to peers, family and friends.

Cost-benefit analysis of Canada's Prison Needle Exchange Program for the prevention of hepatitis C and injection-related infections.

Needle exchange programs are effective public health interventions that reduce blood-borne infections, including hepatitis C, and injection-related infections. We sought to assess the return on investment of existing Prison Needle Exchange Programs (PNEPs) in Canadian federal prisons and their expansion to all 43 institutions. We developed a stochastic compartmental model that estimated hepatitis C and injection-related infections under different PNEP scenarios in Canadian federal prisons. Scenarios projected for 2018-2030 were no PNEP, status quo (actual PNEP implementation 2018-2022, with coverage maintained to 2030), and PNEP scale-up (coverage among people who inject drugs in prison increasing over 2025-2030 to reach 50% by 2030). We calculated the benefit-cost ratio as benefits from health care savings, divided by PNEP costs. By 2019, PNEPs were implemented in 9 of 43 federal prisons, with uptake reaching 10% of people who injected drugs in prison in 2022. Compared with no PNEP, this was estimated to cost Can$0.45 (uncertainty interval [UI] $0.32 to $0.98) million and avert 37 (UI 25 to 52) hepatitis C and 8 (UI -1 to 16) injection-related infections over 2018-2030, with a benefit-cost ratio of 1.9 (UI 0.56-3.0). Compared with the status quo, the PNEP scale-up scenario cost an additional $2.7 (UI $1.8 to $7.0) million and prevented 224 (UI 218 to 231) hepatitis C and 77 (UI 74 to 80) injection-related infections, with a benefit-cost ratio of 2.0 (UI 0.57 to 3.3). Every dollar invested in the current PNEP or its expansion is estimated to save $2 in hepatitis C and injection-related infection treatment costs. This return on investment strongly supports ongoing maintenance and scale-up of the PNEP in Canada from an economic perspective.

I Don’t Want to Shoot up the Meth Anymore: Pipe Distribution as a Harm Reduction Service for People Who Use Methamphetamine

Background Methamphetamine use is disproportionately high in rural settings, with rates increasing during the COVID-19 pandemic. While syringe service programs reduce disease transmission among people who inject drugs, limited research exists around the value of smoking equipment, specifically pipes, in minimizing harms associated with rural methamphetamine use. Methods We conducted semi-structured interviews with people who use methamphetamine in rural southern Illinois. Inclusion criteria involved methamphetamine use in the past 30 days. Interview guides explored attitudes and behaviors regarding pipe use practices and pipe access. Interviews were recorded, transcribed, and coded. The data were analyzed for emergent themes using a sequential, deductive process. Results Nineteen participants, average age 37.1 (SD + 8.7), were interviewed. 53% were women, and 89% were white. All reported smoking methamphetamine, and 84% reported injecting. Participants reported engaging in smoking instead of injection to decrease wounds, pain, and infections. Smoking enabled some to use socially as opposed to alone, as was typically the case when they injected. Participants expressed interest in pipe distribution through a harm reduction agency. They shared that, were a harm reduction agency to distribute pipes, it would connect people to other services such as HIV testing, naloxone, and safer sex supplies. Conclusions Pipe distribution may function as a harm reduction strategy by decreasing injection and solitary drug use and linking patients to additional services. Given disproportionate methamphetamine use in rural regions, this intervention could specifically address drug-related harms that impact rural populations.

Factors associated with PrEP awareness and use among men who have sex with men who use drugs in the Southern United States

ABSTRACT Pre-exposure prophylaxis (PrEP) dramatically reduces HIV transmission risk. PrEP is underutilized among men who have sex with men who use substances (SU-MSM) in the Southern U.S., for whom there is limited research and high PrEP need. Using cross-sectional data from the National Institute on Drug Abuse (NIDA) Clinical Trials Network (CTN) 0082 study, we explored factors associated with PrEP awareness and use among 225 SU-MSM in the Southern U.S. Participants were recruited from community-based sexually transmitted infection clinics, syringe services programs and outpatient substance use treatment programs in eight cities across five Southern states with high HIV incidence. Multinomial logistic regressions examined PrEP awareness and use relative to sociodemographic factors, sexual behaviors and substance use. Results demonstrated overall high awareness, yet limited uptake of PrEP. Younger age, higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP awareness. Higher education, condomless anal sex and more frequent popper use were associated with greater odds of PrEP use. Results highlight the need for innovative PrEP outreach to Southern SU-MSM that accounts for age, education and substances used.

Association of safer smoking supply distribution with participant encounters and naloxone distribution from syringe services programs: Findings from the National Survey of Syringe Services Programs in the United States.

In response to the recent and growing shift from injecting heroin to smoking fentanyl, an increasing number of syringe services programs (SSPs) in the United States are distributing safer smoking supplies. There is a lack of research on whether safer smoking supply distribution is associated with increased SSP engagement and naloxone distribution from SSPs. Therefore, we aimed to assess predictors of safer smoking supply distribution by SSPs and estimate associations between safer smoking supply distribution and scale of harm reduction services. We used cross-sectional data from the National Survey of Syringe Services Programs, which surveyed SSPs from March and August 2023 about services delivered in 2022. We examined factors associated with safer smoking supply distribution and estimated associations between smoking supply distribution and the number of participant encounters and naloxone doses distributed. Of the 429 SSPs included, 187 (44.1 %) distributed safer smoking supplies to participants. SSP organizational type, service delivery method, urbanicity, and regional Census divisions were associated with safer smoking supply distribution. Compared to SSPs that did not distribute safer smoking supplies, those that did reported more participant encounters (aRR=1.62, 95 % CI: 1.19-2.20) and naloxone doses distributed (aRR=1.26, 95 % CI: 0.91-1.74). SSPs distributing safer smoking supplies had greater participant engagement and naloxone distribution. To maximize their full individual and population-level health benefits, SSPs should be supported technically, legally, and financially to implement safer smoking supply distribution for their participants.

Adverse childhood experiences, resilience, and syringe services program attendance among persons who inject drugs in Northeast Georgia, USA: A mediation analysis.

Syringe services programs (SSP) are evidence-based venues offering harm reduction services to persons who inject drugs (PWID), such as sterile syringes, STI/HIV testing, and linkage to care to decrease drug use-related morbidities and mortalities. Adverse childhood experiences (ACEs) have been linked with reduced resilience, while increased resilience can help PWID attend SSPs. This study examined the potential mediating role of resilience between ACEs and SSP attendance among PWID. Data were collected from adult HIV-negative PWID in northeast Georgia, between February-December 2023 (N = 173). Data were collected on SSP attendance (Yes vs. No), resilience, and ACEs. Covariates included age, gender, sexual orientation, race/ethnicity, education, homelessness, HIV risk behavior, syringe sharing, syringe use frequency, and primary drug. Path analysis was performed using Stata 18.0. The majority of PWID were cisgender men (68.8 %), heterosexual (92.5 %), homeless (93.6 %), had HIV risk behavior (65.9 %), had high resilience (54.3 %), and had never attended SSP (64.2 %). The mean number of ACEs was 4.1 (SD=3.2). After adjusting for covariates, high resilience was positively associated with SSP attendance (β= 0.204; p = 0.005). ACEs were negatively associated with high resilience (β= -0.035 p = 0.005) and SSP attendance (β= -0.026; p = 0.034). ACEs had a significant indirect effect on SSP attendance through high resilience (β= -0.007; p = 0.044). Results indicate that resilience may mediate the relationship between ACEs and SSP attendance among PWID. It is important to develop and implement trauma-informed and resilience-based interventions to address the mental and sexual health challenges of PWID with a history of ACEs.

Morality boundary work in the making of the needle and syringe exchange program in Stockholm

Background Drug policy is prone to build on rationales based on different moralities rather than evidence. Less is known about how moralities influence drug policy implementation in practice. The aim was to analyze expressions of moralities among local policy-makers, professionals, and drug users in the context of the Stockholm needle and syringe exchange program (NSP). Methods Using political documentation from Stockholm (2003–2016), focus group (12 NSP staff), and 32 drug user interviews, moralities concerning drug policy and harm reduction were analyzed based on moral foundations theory and boundary work. Results Three main moral dilemmas were identified concerning the subjects, aims, and orientation of drug policy: whether drug users are worthy of inclusion to society; if the general public should be prioritized or the health of drug users, and the orientation of practices as based on control or autonomy. Policy debate was driven by virtues such as purity and authority, whereas staff and drug users valued care, fairness and liberty. Conclusions The prohibitionist and abstinence-oriented Swedish drug policy has created social boundaries on the practice-level. Hence, users’ perspectives, and those who care about them, should be extensively involved in political discussions to foster a more moral and humane drug policy.

Detected substance abuse among injecting drug users through analysis of used syringes in Tunisia

Background and aimsInjecting drug use poses significant public health risks due to unsafe practices such as syringe sharing, reuse, and risky sexual behaviors, which increase the transmission of bloodborne viruses. In Tunisia, limited data on injecting drug use hinders the development of informed health and harm reduction policies. MethodsA syringe collection campaign was conducted in Tunis in November 2022. The used syringes were provided by the Tunisian Association for Information and Orientation on AIDS and Addiction (ATIOST), a harm-reduction service. These syringes had been distributed to people who inject drugs (PWID) as part of a mobile syringe exchange program. The objective of the study was to analyze the contents of the used syringes to gain further insights into drug use patterns among PWID. The residual substances in the syringes were examined using ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS), in accordance with the standardized protocol of the European Syringe Collection and Analysis Project Enterprise (ESCAPE). ResultsA total of 261 syringes from five collection sites were analyzed. Among these, 87 % contained at least one psychoactive substance, while 32 % contained more than two psychoactive substances. The most frequently identified psychoactive substances were buprenorphine (50.28 %), amphetamine (11.65 %) and tramadol (9.66 %). No substances were detected in 34 syringes. ConclusionThis method provides rapid data on drug use trends in specific regions and timeframes, revealing differences that can inform tailored prevention and harm reduction strategies. Such analyses are valuable for comparative studies across countries in the European Neighbourhood Policy (ENP-South) region.

Reaching people who use drugs with sexual and reproductive healthcare through syringe services programs: potential promise and missed opportunities

BackgroundPeople who use drugs are at elevated sexual and reproductive health risk but experience barriers to services. Syringe services programs (SSP) are an important venue to provide integrated health services. Few studies have examined SSP use within intersecting gender, racial, and ethnic groups, including by injection drug use (IDU), and differences in sexual and reproductive health among these groups.MethodsWithin a cohort study among people who use unprescribed opioids in New York City, we conducted a nested cross-sectional study from November 2021-August 2022 assessing sexual health with a survey (n = 120). The parent study measured baseline characteristics, and the cross-sectional study survey measured self-reported past-year SSP use and sexual and reproductive health. We estimated SSP use within gender, racial, and ethnic groups by IDU, and the prevalence of sexual and reproductive health outcomes by gender, race, ethnicity, and SSP use.ResultsAmong men (n = 61) and women (n = 54), SSP use was disproportionately low among Black participants irrespective of IDU. Women reporting SSP use had a higher prevalence of multiple, new, sex trade, and/or casual sex partners, history of STI symptoms, and lack of effective STI prevention, although women who did not use SSP had non-negligible levels of risk with variation between racial and ethnic groups. Among men, sexual and reproductive health varied across racial and ethnic groups but not as clearly by SSP use.ConclusionsSSP offer opportunity to address elevated STI risk among people who use drugs but may miss certain intersecting gender, race, and ethnic groups.

Depressive symptoms and determinants among people who inject drugs in Kaduna State, Nigeria

Background: People who inject drugs (PWID) are known to have higher rates of mental health disorders, particularly depression. Despite this, there is a lack of research on the prevalence of depression among PWID in Nigeria.Aim: This study aimed to determine the prevalence of depressive symptoms and their determinants among PWID.Setting: The study was conducted in Kaduna State, Northwest Nigeria where a needle and syringe programme (NSP) for PWID was recently initiated.Methods: A cross-sectional survey was conducted among PWID using a multi-stage sampling technique. Data were collected using structured interviews and digitalised questionnaires covering socio-demographics, depression symptoms (PHQ-9) and perceived social support (MSPSS).Results: A total of 525 participants were included in the study, with the majority being males (73.3%) aged 24–35 years (54.5%). The study revealed a high prevalence of depressive symptoms among PWID, with 47.4% reporting major symptoms. Predictors of depression identified among PWID included older age, female gender, divorce, unemployment, having primary education and moderate social support.Conclusion: The study underscored a concerning prevalence of depressive symptoms among PWID, notably linked to diverse sociodemographic factors, emphasising the need for holistic, context-specific mental healthcare approaches for this population.Contribution: This study contributes to the limited research on the mental health of PWID in Nigeria. It highlights the need for targeted mental health interventions that consider the unique sociodemographic characteristics of this population.