Sector News

  1. Posted in:

    Declines in Assisted Injection


    • 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.


    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.


    • 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.


    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. Racialized Risk Environments of those Who Inject Drugs in the United States

    Key terms
    Radicalized Risk Environment: occurs when racial/ethnic groups inhabit places that do not have protective resources (for example, substance abuse treatment programs).

    Risk Environment Model: addresses social situations, structures, and places that generate vulnerability to HIV transmission and other drug-and HIV-related harms among people who inject drugs (PWID).

    Participant population
    The sample included 9170 people who inject drugs from 15 states across the United States.

    – Across all measures black PWID were more likely than white PWID to live in areas associated with vulnerability to HIV and poorer outcomes for those living with HIV.
    – Black PWID lived in more socially and economically distressed areas, had poorer access to substance abuse treatment, experienced greater exposure to drug-related law enforcement, were isolated in environments that lacked ethnic diversity and were more likely to experience the combination of hyper segregation and concentrated poverty.
    – Black PWID participants tended to live in states with laws that did not facilitate access to sterile syringes (where a prescription was required for purchase and possession of syringes). Laws restricting syringe access are connected with higher HIV prevalence. Laws limiting sterile syringe access may exacerbate racial/ethnic disparities in HIV prevalence.
    – Interestingly, the authors found a tendency for a law and order approach in states where people who misuse substances are more likely to be thought of as black and a more public health approach where people who misuse substances are thought to be white.
    – Black PWID had better spatial access to HIV testing than white PWID, yet they had worse access to substance abuse treatment. The US public health system made an effort to increase HIV testing amongst black adults; the authors suggest that similar initiatives are needed to increase access to substance abuse treatment as well.
    – The authors encourage those outside of the US to explore the “racialized risk environment” in their own countries. Previous studies have found large disparities in HIV prevalence in Canada among First Nations, the ethnic minority PWID, vs. the ethnic majority PWID. This may result from systematic differences in exposure to high-risk environments that perpetuate social inequality.

    The environments of people who inject drugs appear to be racialized in the US. Future research should assess risk environments in other countries.

    Cooper, H.L.F., Linton, S.L., Kelley, M.E. (2016). Racialized risk environments in a large sample of people who inject drugs in the United States. International Journal of Drug Policy. 27: pp.43-55.

  3. Posted in:

    Factors Influencing Women’s Injection Drug Practices


    Unsafe injecting drug use (IDU) is a significant factor in HIV transmission among women who inject drugs. Risk behavior varies and may differ according to social, contextual, and behavioural domains. Women injection drug users face higher risks of disease than men.


    • In-depth interviews with 26 participants

    Theoretical Approach

    • Grounded Theory which involves “generating theory and doing social research as two parts of the same process” in order to understand participant, concerns, actions, and behavior (Glasser, 1978).


    Theme 1: Transition from non-injection to injection drug use (IDU)
    Cost of sniffing or smoking drugs was cited as primary reason for deciding to inject.
    Considered a social experience shared with friends, partners, and spouses.
    Advised by peers about the benefits: use less drugs; spend less money; and get a better, quicker high than if they sniffed.

    Theme 2: Ways into drug injecting
    No women were alone the first time they injected.
    A friend or relatives injected more than half of the participants.

    Theme 3: Shift towards autonomy or reliance
    Most participants identified as self injectors
    Those who required injecting assistance often spoke of “being second on the needle.” These individuals reported experiences of physical harm and damage to veins.

    Results Summary
    The transition process from non-injection drug use to injection drug use (IDU) was largely influenced by a woman’s social network. Women injection drug users were often the ones to encourage the uptake through the spread of myths such as: more efficient, a way to curtail daily drug costs, and promise of amplified high
    Women expressed pressure of their social network prior to injecting.
    Interestingly, many women received their first injection from a female friend or relative rather than male partner.
    Several respondents required injection assistance throughout their injecting career due to lack of knowledge or deference to an injector because of anxiety or withdrawal.
    Women who require injection help are more likely to share syringes.

    Findings suggest a need for the development of peer-driven interventions with strong female representation to dispel myths to dissuade women from transitioning to injection drug use. In addition, interventions should address personal capability of self- injection due to the additional negative health risks associated with injection by others. Although the findings are not generalizable to other WIDU populations, findings highlight the importance of targeting interventions towards the specific needs of women injection drug users.

    Tuchman, E. (2015). Women’s injection drug practices in their own words: a qualitative study. Harm Reduction Journal. Vol., 12. Pp. 6.

  4. Learn How to Use OHRDP’s New Best Practices Filter!

    OHRDP distributes a sterile cotton pellet filter in a blister pack of five. These cotton filters: meet best practice recommendations, have a pore width of 0.22µm (so they hold less of the drug), are sterile, and save staff and volunteers time because they no longer need to package filters in baggies like they did with the old filters. Service users may be familiar with this new product because they are the same filter that comes in the Stericup cooker. However, for service users who may be new to this product, OHRDP created this step-by-step guide on how to use the new filter product.

  5. Endocarditis Informational Poster

    Counterpoint Regional HIV/AIDS Connection is the Needle Syringe Program (NSP) in London, Ontario. The service providers of this NSP were concerned about the number of clients recently hospitalized with endocarditis, so their team created an informational poster. This poster highlights the symptoms of endocarditis and it also warns clients to seek medical attention if they are experiencing these symptoms. Counterpoint is happy to share this resource with other NSPs. Please feel free to use and pass along!


  6. Safer Injection Pamphlet – NOW AVAILABLE!

    The OHRDP launched a new Safer Injection Pamphlet at the 2014 Harm Reduction Conference. Thank you to everyone from across the province of Ontario who provided feedback and input on this new resources! Hard copies can be ordered from at no cost. We would like to extend a special thank you to Vancouver Coastal Health for sharing their original work with us.

    View Pamphlet Here