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.

Infections[edit]

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[edit]

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[edit]

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[edit]

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 1990-1996, 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]

References[edit]

  1. ^ "Sharing needles to inject drugs, and HIV". Avert. 2015-06-23. Retrieved 2019-11-14.
  2. ^ a b "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. ^ a b "Health-care waste".
  7. ^ a b "Safely Using Sharps (Needles and Syringes) at Home, at Work and on Travel". 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. ^ a b 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. 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. ^ a b c "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. ^ a b 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 (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. ^ "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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