Consider the Source: Associations between Syringe Sources and Risky Injection Behaviors in California’s Central Valley

Abstract

Background

Sterile syringe access is critical to prevent serious viral and bacterial infections among people who inject drugs (PWID) but many areas across the United States lack sufficient access. Although California law allows nonprescription pharmacy syringe sales and syringe services programs (SSPs), access gaps remain in the largely rural Central Valley.

Objective

The purpose of this study was to examine syringe access and related injection behaviors among PWID in Fresno, California.

Methods

We used respondent driven sampling to recruit 494 individuals for a survey about syringe access and injection behaviors between April and September 2016. Participants were ≥18 years old and injected at least twice in the past 30 days. Descriptive statistics examined syringe access and logistic regression determined if discrete syringe source categories were significantly associated with syringe sharing and/or reuse.

Results

A majority (67%) obtained syringes from an authorized source; SSPs were most common (59%), while few reported pharmacy purchase (14%). Unauthorized sources were even more common (79%), primarily friends (64%) or someone on the street (37%). Compared to PWID who used only authorized sources, those using only unauthorized sources had a higher odds of syringe sharing (AOR = 3.40, 95% CI: 1.66, 6.95) and syringe reuse (AOR = 6.22; 95% CI: 2.24, 17.29), as did those who reported mixed sources (AOR = 3.78; 95% CI: 1.90, 7.54 and AOR = 4.64; 95% CI: 2.08, 10.35).

Conclusions

Our findings demonstrate a need to expand syringe access in nonurban California to prevent the syringe sharing and reuse that contributes to serious viral and bacterial infections among PWID.

Keywords:

• People who inject drugs (PWID)
• injection
• syringe access
• syringe services programs (SSPs)
• pharmacies

Acknowledgements

The authors wish to thank the study participants, research staff, and community partners for their contributions to this work.

Declaration of interests

All authors declare that they have no conflicts of interest.

Additional information

Funding

The study was funded by the National Institute on Drug Abuse R01DA040807.