Risky Injection Behaviors are Established at the Onset of Injection Drug Use

The circumstances surrounding the first injection experience of young injection drug users are significantly linked to future injection behavior, according to a new study from researchers at the Johns Hopkins Bloomberg School of Public Health and other institutions. The researchers found that people who first injected drugs with a syringe that had previously been used by someone else were much more likely to report sharing syringes later, when compared with those who used a new syringe at first injection. The study is published in the March 7, 2005, issue of Drug and Alcohol Dependence.

“We need to reach drug users before they start injecting. They need to be made aware of the dangers of sharing syringes. We were happy to see that injection drug users who had heard of the Baltimore, Md., syringe exchange program before they started using injection drugs were less likely to share used syringes, which puts them at a lower risk of contracting HIV, hepatitis C and other diseases,” said Laura A. Novelli, MHS, lead author of the study and a graduate student at the Bloomberg School of Public Health at the time the research was completed.

The study authors reviewed data collected by outreach workers affiliated with the REACH III study, a Baltimore-based study of drug users. The authors reviewed data derived from interviews with 420 injection drug users, aged 15-30 years, who had been injecting drugs for less than five years.
The researchers found that the majority of study participants who reported sharing syringes in the six months prior to their interview were young (median age, 23 years), white males who had not finished high school and did not have a steady job. Most were also homeless.

Over 38 percent of the study participants said they had recently injected with a used syringe, and of these 37 percent reported sharing syringes when they first injected. In contrast, about half of the study participants who said they did not share needles got their first syringe from a pharmacy or syringe exchange program.

Drug users who reported sharing syringes at the time of the first injection were more likely to be younger in age, to be injected by someone else and to have used a syringe that had previously been used by someone else, when compared with injection drug users who reported they did not currently share syringes.

“How injection drug users start using drugs can foretell their future injection behaviors and risk of acquiring infectious diseases. There is understandably an intense effort to promote healthy practices among injection drug users, but there are also a number of benefits in working with non-injection drug users as well—in preventing transition to injection drug use as well as education. If we aren’t able to prevent injection initiation, we can educate drug users, which will decrease their risk of contracting HIV, hepatitis C and other blood-borne diseases,” said Susan G. Sherman, MPH, PhD, corresponding author of the study and an assistant professor in the Department of Epidemiology at the Bloomberg School of Public Health.

“Circumstances surrounding the first injection experience and their association with future syringe sharing behaviors in young urban injection drug users” was supported by a grant from the National Institute of Drug Abuse.

Additional authors of the study were Jennifer R. Havens, Marcella Sapun and Steffanie A. Strathdee.