Access to safer injection equipment among people who inject drugs utilizing medical services in an urban hospital in the United States

Abstract

Injection drug use carries significant risks for injury and infection, particularly when injection supplies are reused or shared. Syringe service programs and pharmacy nonprescription sale of syringes minimize this risk by promoting access to supplies. This study aimed to characterize how individuals accessing medical care obtain supplies and the impact of perceived barriers to accessing safer injection supplies. One hundred and twenty participants reporting past seven-day injection drug use were recruited from a large urban academic medical center. Participants completed a survey about their injection drug use practices, access to injection supplies, as well as barriers to accessing supplies. Most participants (68%) reported obtaining syringes from multiple sources over the past 3 months, most commonly syringe service programs (78%) or a pharmacy (68%). Few (3%) reported obtaining supplies from medical settings. Participants who found syringes easy to obtain were less likely to report reusing a syringe >10 times (25% vs. 81%, p < .001). More participants were comfortable obtaining syringes through syringe service programs (89%) than nonprescription sale of syringes (60%, p = .001). Perceiving syringe service programs as not convenient or not comfortable reduced the odds of obtaining syringes there by 90% (p < .001) and 88% (p < .003), respectively. Perceiving pharmacies as not comfortable or not affordable reduced the odds of obtaining syringes there by 82% (p < .001) and 75% (p < .002), respectively. Even in regions with legalized syringe service programs and nonprescription sale of syringes, barriers to accessing safer injection supplies remain, and may be partially addressed by expanding syringe service program hours and locations, addressing cost of nonprescription sale of syringes, pharmacy staff training, and expansion of injection supply distribution in medical settings.

Keywords:

• Injection drug use
• syringe service programs
• substance use disorder
• pharmacy non-prescription syringe sales
• safe injection practices

Disclosure statement

Dr. Sarah Wakeman is an author for uptodate and a textbook editor for Springer and Wulter Kluwer. She previously served on a clinical advisory board for Celero systems but no longer does. Dr. Karen Donelan has received grant funding through Rize Massachusetts to Brandeis University to study organizations and frontline workers providing harm reduction services. Dr. Laura Kehoe has received an honorarium from Indivior for a nonbranded educational talk and advisory board meeting. The remaining authors report no conflicts of interest.

Additional information

Funding

This research was funded in part by a private foundation grant from RIZE Massachusetts.