Study Examines Harm Reduction Among Injection Drug Users

Nearly half of injection drug users disposed of their used syringes safely, yet only 28 percent acquired their needles from safe sources, according to a study of injection drug users in Baltimore, Md., conducted by researchers at the Johns Hopkins Bloomberg School of Public Health. Syringe sharing among injection drug users is a major risk factor for the spread of HIV and other diseases. Improperly discarded used needles could pose a similar risk to the entire community. The study is among the first to examine safe syringe acquisition and disposal among new, young injection drug users. The results are published in the February 2005 edition of the Journal of Drug Issues.

The study included 294 injection drug users between the ages of 15 and 30, who were a part of a larger study of HIV infection among new drug users in Baltimore and who reported injecting drugs for less than five years. They were questioned about their drug injection habits, including from whom and where they acquired their syringes and how they disposed of used syringes. “Safe sources” were the Baltimore syringe exchange program or pharmacies. “Safe disposal” was defined as discarding used syringes at syringe exchange programs, breaking the needle off before discarding or placing the syringe in a hard container before throwing it away.

According to the study, 10 percent of study participants cited the Baltimore syringe exchange program as their primary source for acquiring needles compared to 18 percent from pharmacies and 50 percent who reported needle sellers as their primary source. Twenty-two percent of the participants reported following both safe acquisition and disposal practices. Safe injection and disposal were not associated with HIV, hepatitis C or syringe sharing.

“Among the people we surveyed, those who had injected drugs for more than two years were two and a half times more likely to get their syringes from safe sources compared to those who have been injecting for shorter periods of time. Participants who acquired syringes from safe sources were more likely to dispose of them safely,” said Susan Sherman, PhD, the study’s lead author, who is an assistant professor in the Department of Epidemiology at the Bloomberg School of Public Health. “This indicates the importance of syringe exchange programs targeting newly initiated injectors, as syringe exchange programs are an important and often times the only health prevention resource for injection drug users. More research is needed to determine if our findings are similar in cities without syringe exchange or pharmacy sale programs.”

“Providing safe needles to injection drug users is very controversial in the U.S., although it is a vital component of HIV prevention throughout the rest of the industrialized world and is an important HIV and hepatitis prevention for new injection drug users,” said Dr. Sherman.

Melanie Rouch, MHS, doctoral student with the Department of Health Care and Epidemiology at the University of British Columbia and Elizabeth T. Golub, PhD, assistant scientist with the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health contributed to the article “Correlates of Safe Syringe Acquisition and Disposal Practices Among Young IDUs: Broadening our Notion of Risk.”

The study was funded by grants from the National Institute on Drug Abuse.