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    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.