Sector News

  1. Posted in:

    Declines in Assisted Injection

    Background

    • Research shows that those who get assistance injecting are an especially vulnerable subgroup of people who inject drugs (PWID).
    • However, an injection by another person is common amongst PWID. A previous study found that 41% of PWID in a Canadian city reported assisted injecting within the last 6 months.
    • Those who receive assisted injection are at significant risk of several negative health outcomes. Usually people who help others inject use the same syringe. As well, there is an association between requiring help with injection and syringe sharing, which puts theses individuals at a great risk for blood-borne illnesses.
    • Assisted injecting is strongly associated with HIV and HCV.
    • A previous Canadian study found that those who get assistance with injecting are at over twice the risk of acquiring HIV.
    • Women who inject drugs may be more likely than males to require assistance with injection. Although the reasons for injection assistance may be gendered, other reasons for assisted injecting include a lack of viable veins, reliance upon jugular injection, being in withdrawal, and a lack of knowledge of how to inject.

    Approach

    The authors conducted a gender-based analysis among 1119 people who inject drugs (PWID) in Vancouver to look at trends in the rates of requiring assistance with injection.

    Findings

    • The authors found that rates of assisted injection in last 6 months declined between 2006 and 2014 for both males (21.9 to 13.8 %) and females (37.0 to 25.6 %).
    • However, syringe borrowing remained positively associated with assisted injecting females and in more recent years among males.
    • For women, daily heroin injection, anxiousness and dope sickness emerged as reasons for requiring injection assistance.
    • The most frequently listed reasons for assisted injecting were similar between males and females. The reasons included: jugular injection; bad veins/no veins; and being anxious/dope sick.
    • The amount of both men and women who reported a lack of injection technique as a reason for assisted injection decreased in recent years.
    • However, rates of assisted injection continue to be high despite the decline shown in this study. This is particularly true for females as they have higher rates of assisted injecting in comparison to males.
    • A troubling finding is that the association between assisted injecting and syringe borrowing seems to have strengthened in recent years.
    • For both men and women, injecting in public was continually associated with assisted injecting.

    Conclusion

    The rates of assisted injection among people who inject drugs is declining. Possibly, this may be related to increased awareness of the risks associated with assisted injecting due to improved access to harm reduction information and interventions. However, it is important to recognize that, overall, assisted injecting remains high, particularly among women.

    Pedersen, J.S., Dong, H., Small, W., Wood, E., Nguyen, P., Kerr, T., and Hayashi, K. (2016).Declining trends in the rates of assisted injecting: a prospective cohort study. Harm Reduction Journal. 13:2.

  2. Naloxone as Treatment for Opioid Overdose

    Summary

    • Between 1999 and 2012, opioid-related deaths over tripled from 1.4 to 5.1 per 100,000.
    • Opioid painkillers are the most common prescription medication related to overdose deaths.
    • A drug called naloxone can treat opioid overdoses. Administration of the treatment is easy because it can be sprayed into an unconscious person’s nose, does not require intravenous access, and reduces needle prick risks.
    • Many states have reduced restrictions of naloxone use by emergency responders and have developed programs for naloxone distribution to opioid abusers in order to reduce opioid-associated mortality. There are at least 188 programs that currently distribute naloxone throughout the U.S.
    • Over 10,000 successful opioid overdose reversals were reported between 1996 and 2010 by naloxone distribution programs. This shows that naloxone can prevent overdose death when administered by bystanders with limited training.
    • Amended laws in 30 states now make it easier for medical professionals to prescribe and dispense naloxone, and for bystanders to administer it, by removing or reducing liability if something goes wrong.
    • Good Samaritan Laws allow bystanders to call 911 to report an overdose without fear of arrest (Law Atlas The Policy Surveillance Portal, 2015).
    • A community-based prevention program, Project Lazarus, partnered with local physicians and provided naloxone as part of their routine medical care to both suspected opioid abusers and pain patients who were at high risk for overdose. They also provided enhanced education for prescribing physicians. In that program, opioid-associated deaths decreased by 50% in one year.

    In the last two decades, opioid prescribing has increased considerably in the U.S. This is partly due to significant changes in clinical practice guidelines for improved pain control. This may have lead to broader opioid prescribing for chronic pain leading to increased availability of opioids, and increased marketing of opioids. Naloxone is a therapeutic drug used for opioid overdose reversal currently used by first responders and hospitals. Overall, naloxone distribution and training programs have shown to be effective in reducing opioid associated mortality.

    Coe, M.A., and Walsh, S.L. (2015).Distribution of naloxone for overdose prevention to chronic pain patients. Preventative Medicine. 80:41-43.

  3. Good News for Good Samaritans!

    The Good Samaritan Overdose Act is now law in Canada.

    This will help to save lives.  To learn more, see News Release from Health Canada.