Injecting substance use in prisons in the United States: a case for needle exchange programs

Despite efforts to prevent illicit substance use in prisons, inmates in many countries still have access to them, along with associated paraphernalia. In the United States, a large proportion of people in prison are there due to drug-related charges. The secretive nature of illicit substance use in prison and the opposition to implementing harm reduction interventions such as needle exchange programs have put prisoners who engage in such practices at high risk for infectious bloodborne diseases. While states have their reasons for opposing the implementation of needle exchange programs in prisons, evidence shows that keeping illicit substances out of prisons is difficult. Programs allowing needle exchange programs are currently illegal in the United States. The authors propose that states reconsider their stance on needle exchange programs as the implementation of such programs in several penal institutions worldwide have proven to be successful in reducing bloodborne diseases and promoting and preserving the health of prisoners. By prohibiting needle exchange programs in prison states are not only denying prisoners' access to health care but are also violating prisoner's right to health as recommended by international instruments on prisoner rights. This article advocates for the implementation of needle exchange programs in the United States prison system with a focus on states. It does this by drawing attention to the effectiveness of such programs around the world and to the fact that incarceration does not necessarily reduce illicit substance use.

The effect of the needle exchange program on the spread of some sexually transmitted diseases

In this paper we consider a model for the spread of a sexually transmitted disease considering sexual transmission and spread via infected needles among intravenous drug users. Besides the transmission among drug users, we also consider sexual contacts between intravenous drug users and non-drug users. Furthermore, the needles are considered as a vector population. For several European countries, a sharp increase of sexually transmitted diseases was reported and several others are rated as endangered based on the number of syringes given out per intravenous drug users per year. The main purpose of the paper is to investigate the dynamics of this model including the effect of needle exchange and study the risk of an increased transmission among non-drug users, induced by the reduction of the needle exchange program. Following the determination of the basic reproduction number R₀ it is shown that all solutions tend to the unique disease-free equilibrium if R₀ < 1. We also prove that the disease persists in the human population if R₀ > 1. Our numerical simulations, based on real life and hypothetical data for HIV, suggest that a decrease in the rate of the distribution and discharge rate of new needles might imply that the considered disease is becoming endemic in the considered human population of drug users and non-drug users. A variant of our model with time- variable needle distribition parameter is fitted to recent HIV data from Hungary to give a forecast for the number of infected in the following years.

Hepatitis C Prevention and Needle Exchange Programs in Rhode Island: ENCORE

As Rhode Island's only needle exchange program, ENCORE (Education, Needle Exchange, Counseling, Outreach, and REferrals) serves a wide range of clients infected or at risk for infection with hepatitis C virus (HCV). Through its on-site and outreach platforms across Rhode Island, ENCORE is in a unique position to serve at-risk individuals who may not otherwise present for prevention, testing and care for HCV, as well as human immunodeficiency virus (HIV). In this article, we discuss the role of needle exchange programs in preventing HCV transmission, and provide an overview of the history and current operations of ENCORE.

Syringe acquisition experiences and attitudes among injection drug users undergoing short-term opioid detoxification in Massachusetts and Rhode Island

Access to sterile syringes for injection drug users (IDUs) is a critical part of a comprehensive strategy to combat the transmission of HIV, hepatitis C virus, and other bloodborne pathogens. Understanding IDUs' experiences and attitudes about syringe acquisition is crucial to ensuring adequate syringe supply and access for this population. This study sought to assess and compare IDUs' syringe acquisition experiences and attitudes and HIV risk behavior in two neighboring states, Massachusetts (MA) and Rhode Island (RI). From March 2008 to May 2009, we surveyed 150 opioid IDUs at detoxification facilities in MA and RI, stratified the sample based on where respondents spent most of their time, and generated descriptive statistics to compare responses among the two groups. A large proportion of our participants (83%) reported pharmacies as a source of syringe in the last 6 months, while only 13% reported syringe exchange programs (SEPs) as a syringe source. Although 91% of our sample reported being able to obtain all of the syringes they needed in the past 6 months, 49% had used syringes or injection equipment previously used by someone else in that same time period. In comparison to syringe acquisition behaviors reported by patients of the same detoxification centers in 2001-2003 (data reported in previous publication), we found notable changes among MA participants. Our results reveal that some IDUs in our sample are still practicing high-risk injection behaviors, indicating a need for expanded and renewed efforts to promote safer injection behavior among IDUs. Our findings also indicate that pharmacies have become an important syringe source for IDUs and may represent a new and important setting in which IDUs can be engaged in a wide array of health services. Efforts should be made to involve pharmacists in providing harm reduction and HIV prevention services to IDUs. Finally, despite limited SEP access (especially in MA), SEPs are still used by approximately one of the three IDUs in our overall sample.

A cross-sectional assessment of utilization of addiction treatment among injection drug users in Kabul, Afghanistan

The purpose of this study was to describe prior use of detoxification and addiction-treatment programs among injection drug users (IDUs) in Kabul, Afghanistan. From 2005-2006, IDUs (n = 464) recruited into this cross-sectional study completed an interviewer-administered questionnaire and whole blood rapid testing with fingerstick samples for HIV, syphilis, and hepatitis C antibody and B surface antigen testing. Participants were predominantly male (99.8%), Afghan (98.9%), and had little formal education. Correlates of detoxification and addiction treatment were identified with logistic regression. The majority (94.0%, n = 435) felt great/urgent need for treatment, of whom 56.3% (n = 245) reported inability to access treatment. Prior detoxification was associated with new needle use with each injection (AOR = 1.91, 95% CI: 1.12-3.26) and prior incarceration (AOR = 1.81, 95% CI: 1.04-3.13). The study's limitations are noted. Rapid scale-up and subsidy of needle and syringe programs and opioid agonist treatment is urgently needed in Kabul.

Selection effect of needle exchange in Anchorage, Alaska

Participation bias (selection bias) may be a problem in studies that attempt to evaluate the effects of needle-exchange programs (NEPs). The present study looked at only those injection drug users (IDUs) who were randomly placed in the needle-exchange condition in a two-arm randomized clinical trial of needle exchange. Time to follow-up between the experimental NEP condition (n = 296; median = 261 days) and pharmacy sales condition (n = 304; median = 256 days) was not statistically different [chi(2) (1, N = 600) = 0.42, P =.52]. Within the NEP condition, a similar analysis comparing time to follow-up between IDUs who used the NEP (n = 65; median = 199 days) and those who refrained from using the NEP (n = 231; median = 286 days) was highly significant, chi(2) (1, n = 296) = 17.3, P=.0001. The final logistic regression model predicting use of the NEP was the log 10 transformation of the number of times injected heroin in the last 30 days (odds ratio [OR ]=4.9, confidence interval [CI ]2.8, 8.9), ever injected amphetamine in the last 30 days (OR =4.9, CI 1.09, 22.5), and ever shared injection equipment in the last 30 days (OR =2.9, CI 1.5, 5.5). Within the NEP condition, follow-up rates differed between those who used the NEP and those who did not use it. Of drug users randomly assigned to an NEP, the ones who actually used the NEP had higher levels of drug use. Predictors of who used the NEP were consistent with the studies of Hagen et al. This study demonstrates that selection bias occurs among IDUs who use NEPs.