Needle sharing

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Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. [1] This is a primary vector for blood-borne diseases which can be transmitted through blood (blood-borne pathogens). [2] People who inject drugs (PWID) are at an increased risk for Hepatitis C (HCV) and HIV due to needle sharing practices. [3] From 1933 to 1943, malaria was spread between users in the New York City area by this method. Afterwards, the use of quinine as a cutting agent in drug mixes became more common. [4] Harm reduction efforts including safe disposal of needles, supervised injection sites, and public education may help bring awareness on safer needle sharing practices.

Contents

Infections

Blood-borne diseases are transmitted when a susceptible person uses a needle that was previously used by a person who is infected with these pathogens; hence, sharing needles with other individuals is not a safe practice. [5] It takes one simple prick of a contaminated needle to put someone at risk of acquiring Hepatitis B, Hepatitis C, or HIV infections with Hepatitis B being the easiest to contract, followed by Hepatitis C then HIV. [6] People who use previously used needles are at increased risk of getting infected with blood-borne pathogens such as HIV, HBV, and HCV, and spreading the infections to others. [7] In addition to HIV, HBV, and HCV, some sexually transmitted infections (STIs) can be transmitted to uninfected individuals due to the risky injection practices. [8]

According to CDC, in 2013, sharing syringes was the cause of HIV infection in 3,096 out of the 47,352 patients who were newly diagnosed with the disease in the United States. [2] According to a study done by New Haven Connecticut's needle exchange program, 67.5% of the needles returned to the facility were contaminated with HIV. [9] Their assumption was that people bringing in “street needles” were shared among other people prior to bringing them to the program. [9] Almost 50% of people who participate in IVDU have Hepatitis C. [10] Not only are blood borne diseases passed via needle sharing, but so are bacterial infections that can ultimately cause sepsis. [6] Additionally, improper disposal of hospital needles can expose drug resistant organisms to the outside environment. [11]

Risk factors for needle sharing

Much research has been done on risk factors that may predispose an individual to needle sharing in an effort to improve the effectiveness of needle-exchange programs (NEPs) and other harm reduction programs for PWID. [12] The barriers that contribute to rates of needle sharing include the lack of accessibility to clean needles and education about safe needle usage. [12] In each respective country, government and cultural views towards PWID and NEPs have an impact on the resources available as demonstrated by studies done in China, [13] France, [14] Vietnam, [15] and India. [16] Within the United States, needle sharing behavior is positively correlated to individuals who are of lower socioeconomic status, younger than 45 years old, male, and unemployed. [17] The incidence of needle sharing was found to be more prevalent in homosexual and bisexual men compared to women and heterosexual men, particularly in minority communities. [17] People of a minority race or ethnicity are often at an increased risk of needle sharing, possibly due to lower levels of health education. [12]

Safe disposal of needles

Discarding needles in regular household trash bins endangers children, pets, janitors, and waste management services personnel; therefore, needles should be properly disposed of in a FDA-cleared sharps container that is both puncture- and leak-resistant. [7] It is important to properly dispose of used needles because it can be difficult to tell if a needle has ever been used before. By not disposing of needles in a safe way, users may expose others or themselves to a needle stick injury. [18] If a sharps container is not available, needles can often be brought to local law enforcement, hospitals, or drug stores for safe collection and disposal. In addition, needles can be mailed in specialized containers to a mail-back program for safe disposal. [19] Moreover, needles can be utilized and disposed of properly in supervised injection sites. In the health care setting, use of blunt-end needles can minimize the risk of needle stick injuries. [20]

Harm reduction

NEPs, also known as syringe exchange programs (SEPs), are a form of harm reduction policy that provide new needles to persons addicted to drugs in exchange for used ones in order to help control the spread of disease. [21] In the United States, there are three distinct prohibitions on needle exchange programs at the federal level—the Ryan White CARE Act, the Substance Abuse and Mental Health Services Administration (SAMHSA) authorization, [22] and the 1997 Labor-Health and Human Services (HHS) Education appropriations legislation. However, many states still provide the service despite the federal legislation, especially in large cities where intravenous drug use is a major health concern. A study in New York State found that during the course of 12 months, NEP prevented roughly 87 infections of HIV by preventing needle sharing. In addition, NEP have decreased the spread of HIV by one third to two fifths. [23]

One of the other harm reduction measurements in this regard is the Supervised Injection Sites, also known as Safe Injection Sites. In these facilities, drug users have access to new needles and they can use substances under the supervision of staff trained to prevent and treat drug overdose and trained to prevent HIV and hepatitis. Some of these sites also provide help to their clients to ease their access to drug treatment and other additional social and medical services. [24] There are some countries around the world that have already established safe injection sites, including Australia and Canada. According to NPR, since the start of this program in Canada in 2013, these sites have supervised over 3.6 million injections and have prevented more than 6,000 overdoses. [25] Additionally, in a cross-sectional survey performed in Glasgow from 1990 to 1996, the incidence of Hepatitis C had significantly decreased with the implementation of safe needle exchanges. [26]

The progression of supervised injection site implementation is currently not widely accepted due to social stigma, lack of government support, and health advocacy. Continued public health education, advocacy efforts, and further research may help encourage the expansion supervised injection sites. [27]

See also

Related Research Articles

<span class="mw-page-title-main">Harm reduction</span> Public health policies designed to lessen the negative consequences associated with human behavior

Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

<span class="mw-page-title-main">Needle and syringe programmes</span> Method of providing drug users with uninfected equipment

A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for blood-borne diseases such as HIV/AIDS and hepatitis.

<span class="mw-page-title-main">Hypodermic needle</span> Device to inject substances into the circulatory system

A hypodermic needle, one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with one sharp tip. It is commonly used with a syringe, a hand-operated device with a plunger, to inject substances into the body or extract fluids from the body. Large-bore hypodermic intervention is especially useful in catastrophic blood loss or treating shock.

<span class="mw-page-title-main">Blood-borne disease</span> Medical condition

A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious agents such as viruses. Three blood-borne pathogens in particular, all viruses, are cited as of primary concern to health workers by the CDC-NIOSH: HIV, hepatitis B (HVB), & hepatitis C (HVC).

<span class="mw-page-title-main">Supervised injection site</span> Medical facility

Supervised injection sites (SIS) are medically supervised facilities designed to provide a hygienic environment in which people are able to consume illicit recreational drugs intravenously and prevent deaths due to drug overdoses. The legality of such a facility is dependent by location and political jurisdiction. Supervised injection sites are part of a harm reduction approach towards drug problems. The facilities provide sterile injection equipment, information about drugs and basic health care, treatment referrals, access to medical staff, and, at some facilities, counseling. Most programs prohibit the sale or purchase of recreational drugs at the facility.

<span class="mw-page-title-main">Injection (medicine)</span> Method of medication administration

An injection is the act of administering a liquid, especially a drug, into a person's body using a needle and a syringe. An injection is considered a form of parenteral drug administration; it does not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into. This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections.

<span class="mw-page-title-main">Needlestick injury</span> Accidental puncture of skin causing contamination

A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of blood-borne diseases, placing those exposed at increased risk of infection from disease-causing pathogens, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Among healthcare workers and laboratory personnel worldwide, more than 25 blood-borne virus infections have been reported to have been caused by needlestick injuries. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the mucous membranes, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers.

<span class="mw-page-title-main">Sharps waste</span>

Sharps waste is a form of biomedical waste composed of used "sharps", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as biohazardous waste and must be carefully handled. Common medical materials treated as sharps waste are hypodermic needles, disposable scalpels and blades, contaminated glass and certain plastics, and guidewires used in surgery.

<span class="mw-page-title-main">Drug injection</span> Method of introducing a drug

Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body. Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision, of which 22% are from developed countries.

<span class="mw-page-title-main">Vancouver Area Network of Drug Users</span> Organization

The Vancouver Area Network of Drug Users or VANDU is a not-for-profit organization and advocacy group based in Vancouver, British Columbia, Canada. The group believes that all drug users should have their own rights and freedoms. The group's members have been actively involved in lobbying for support of Insite, North America's first safe injection site, located in the Downtown Eastside of Vancouver.

Flashblood is an intravenous drug administration technique used by recreational drug users in which an individual injects himself with blood extracted from another drug user, most commonly one who has injected heroin. The purpose of the technique is to experience substance intoxication or to help combat symptoms of drug withdrawal. The practice was first documented in an announcement submitted by Sheryl A. McCurdy, et al., in an October 2005 issue of BMJ. First reported to be practiced in Dar es Salaam, Tanzania, the practice had spread to other areas in East Africa by 2010.

The Journal of Global Drug Policy and Practice describes itself as an open access peer-reviewed public health journal. Critics say it is biased, not peer reviewed, and not a legitimate scientific journal. It is funded by the US Department of Justice.

HIV prevention refers to practices that aim to prevent the spread of the human immunodeficiency virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

Low-threshold treatment programs are harm reduction-based health care centers targeted towards people who use substances. "Low-threshold" programs are programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling and cease all drug use as a precondition of support.

Infectious diseases within American correctional settings are a concern within the public health sector. The corrections population is susceptible to infectious diseases through exposure to blood and other bodily fluids, drug injection, poor health care, prison overcrowding, demographics, security issues, lack of community support for rehabilitation programs, and high-risk behaviors. The spread of infectious diseases, such as HIV and other sexually transmitted diseases, hepatitis C (HCV), hepatitis B (HBV), and tuberculosis, result largely from needle-sharing, drug use, and consensual and non-consensual sex among prisoners. HIV and hepatitis C need specific attention because of the specific public health concerns and issues they raise.

A low dead space syringe (LDSS) or low dead-volume syringe is a type of syringe with a design that seeks to limit dead space that exists between the syringe hub and needle.

Responsible drug use maximizes the benefits and reduces the risk of negative impact psychoactive drugs cause on the lives of the user. For illegal psychoactive drugs that are not diverted prescription controlled substances, some critics believe that illegal recreational drug use is inherently irresponsible, due to the unpredictable and unmonitored strength and purity of the drugs and the risks of addiction, infection, and other side effects.

Gerry Stimson is a British public health social scientist, emeritus professor at Imperial College London from 2004, and an honorary professor at the London School of Hygiene and Tropical Medicine from 2017. Stimson has over 220 scientific publications mainly on social and health aspects of illicit drug use, including HIV infection. He has sat on numerous editorial boards including AIDS, Addiction, and European Addiction Research, and with Tim Rhodes he was the co-editor-in-chief of the International Journal of Drug Policy from 2000 to 2016. He is one of the global leaders for research on and later advocacy for harm reduction.

<span class="mw-page-title-main">Uniting Medically Supervised Injecting Centre</span> Hospital in New South Wales, Australia

The Uniting Medically Supervised Injecting Centre Kings Cross is a state government-supported facility in Kings Cross, New South Wales that provides safe injecting rooms, sterile equipment and medical supervision for individuals who wish to administer an illicit drug intravenously.

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction.

References

  1. ↑ "Sharing needles to inject drugs, and HIV". Avert. 2015-06-23. Retrieved 2019-11-14.
  2. 1 2 "Access to clean syringes | Health Impact in 5 Years | Health System Transformation | AD for Policy | CDC". www.cdc.gov. 2019-07-01. Retrieved 2019-11-14.
  3. ↑ "People who inject drugs". World Health Organization. Retrieved 2017-10-31.
  4. ↑ Helpern M (1977). "An Epidemic of Sorts". Autopsy : the memoirs of Milton Helpern, the world's greatest medical detective. New York: St. Martin's Press. pp. 70–71. ISBN   978-0-312-06211-8.
  5. ↑ "Sharing Needles", BBC
  6. 1 2 "Health-care waste".
  7. 1 2 "Safely Using Sharps (Needles and Syringes) at Home, at Work and on Travel". Food and Drug Administration . 2019-06-15.
  8. ↑ Fu R, Gutfraind A, Brandeau ML (March 2016). "Modeling a dynamic bi-layer contact network of injection drug users and the spread of blood-borne infections". Mathematical Biosciences. 273: 102–13. doi:10.1016/j.mbs.2016.01.003. PMC   5154253 . PMID   26775738.
  9. 1 2 Kaplan EH, Heimer R (1992). "A model-based estimate of HIV infectivity via needle sharing". Journal of Acquired Immune Deficiency Syndromes. 5 (11): 1116–8. PMID   1403641.
  10. ↑ Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, et al. (September 2017). "Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs". The Cochrane Database of Systematic Reviews. 2017 (9): CD012021. doi:10.1002/14651858.CD012021.pub2. PMC   5621373 . PMID   28922449.
  11. ↑ Fernandes RM, Cary M, Duarte G, Jesus G, Alarcão J, Torre C, et al. (April 2017). "Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews". BMC Public Health. 17 (1): 309. doi:10.1186/s12889-017-4210-2. PMC   5387338 . PMID   28399843.
  12. 1 2 3 "People who inject drugs, HIV and AIDS". AVERT. 2015-07-20. Retrieved 2017-11-15.
  13. ↑ Chen X, Zhu L, Zhou YH, Liu FL, Li H, Yao ZH, et al. (August 2016). "Factors associated with needle sharing among people who inject drugs in Yunnan, China: a combined network and regression analysis". Infectious Diseases of Poverty. 5 (1): 73. doi:10.1186/s40249-016-0169-y. PMC   4977866 . PMID   27502491.
  14. ↑ Guichard A, Guignard R, Lert F, Roy E (2015). "Risk Factors Associated with Unsafe Injection Practices at the First Injection Episode among Intravenous Drug Users in France: Results from PrimInject, an Internet Survey". Journal of Addiction. 2015: 507214. doi: 10.1155/2015/507214 . PMC   4609460 . PMID   26504609.
  15. ↑ Hien NT, Giang LT, Binh PN, Devillé W, van Ameijden EJ, Wolffers I (2001). "Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam". Journal of Substance Abuse. 13 (1–2): 45–58. doi:10.1016/S0899-3289(01)00059-1. PMID   11547623.
  16. ↑ Chakrapani V, Newman PA, Shunmugam M, Dubrow R (May 2011). "Social-structural contexts of needle and syringe sharing behaviours of HIV-positive injecting drug users in Manipur, India: a mixed methods investigation". Harm Reduction Journal. 8 (1): 9. doi:10.1186/1477-7517-8-9. PMC   3120658 . PMID   21569478.
  17. 1 2 Mandell W, Vlahov D, Latkin C, Oziemkowska M, Cohn S (June 1994). "Correlates of needle sharing among injection drug users". American Journal of Public Health. 84 (6): 920–3. doi:10.2105/ajph.84.6.920. PMC   1614968 . PMID   8203687.
  18. ↑ "Needle stick injuries". Paediatrics & Child Health. 13 (3): 211–20. March 2008. doi:10.1093/pch/13.3.211. PMC   2529414 . PMID   19252703.
  19. ↑ "Community Options for Safe Needle Disposal" (PDF).
  20. ↑ Parantainen A, Verbeek JH, Lavoie MC, Pahwa M (November 2011). "Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff". The Cochrane Database of Systematic Reviews. 2016 (11): CD009170. doi:10.1002/14651858.CD009170.pub2. PMC   7387125 . PMID   22071864.
  21. ↑ "Syringe Exchange Programs --- United States, 2008". www.cdc.gov. Retrieved 2019-11-14.
  22. ↑ Clemons T. "Needle Exchange Program".
  23. ↑ "Needle Exchange Programs Promote Public Safety".
  24. ↑ "THE ISSUE". YES TO SCS CALIFORNIA. Retrieved 2019-10-24.
  25. ↑ Gordon, Elana (7 September 2018). "What's The Evidence That Supervised Drug Injection Sites Save Lives?". NPR.org. Retrieved 2019-10-31.
  26. ↑ Taylor A, Goldberg D, Hutchinson S, Cameron S, Gore SM, McMenamin J, et al. (March 2000). "Prevalence of hepatitis C virus infection among injecting drug users in Glasgow 1990-1996: are current harm reduction strategies working?". The Journal of Infection. 40 (2): 176–83. doi:10.1053/jinf.2000.0647. PMID   10841096.
  27. ↑ Kerr T, Mitra S, Kennedy MC, McNeil R (May 2017). "Supervised injection facilities in Canada: past, present, and future". Harm Reduction Journal. 14 (1): 28. doi:10.1186/s12954-017-0154-1. PMC   5437687 . PMID   28521829.

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