Suchergebnisse

Supervised injection facilities (SIFs) have been shown to reduce infection, prevent overdose deaths, and increase treatment uptake. The United States is in the midst of an opioid epidemic, yet no sanctioned SIF currently operates in the United States. We estimate the economic costs and benefits of establishing a potential SIF in San Francisco using mathematical models that combine local public health data with previous research on the effects of existing SIFs. We consider potential savings from five outcomes: averted HIV and hepatitis C virus (HCV) infections, reduced skin and soft tissue infection (SSTI), averted overdose deaths, and increased medication-assisted treatment (MAT) uptake. We find that each dollar spent on a SIF would generate US$2.33 in savings, for total annual net savings of US$3.5 million for a single 13-booth SIF. Our analysis suggests that a SIF in San Francisco would not only be a cost-effective intervention but also a significant boost to the public health system.

Drug paraphernalia laws in 47 U.S. states make it illegal for injection drug users (IDUs) to possess syringes. It has been suggested that these laws lead to syringe sharing by deterring IDUs from carrying their own syringes. We examined the relationship between concern about arrest while carrying drug paraphernalia and injection-related risk behaviors among street-recruited IDUs in Northern California. In 1996, 424 IDUs were interviewed, of whom 76 percent were African American, 36 percent were female, and 15 percent were HIV positive. Thirty-five percent (150) reported concern about being arrested while carrying drug paraphernalia. In multivariate analyses that controlled for potential confounders, IDUs concerned about being arrested were significantly more likely than other IDUs to share syringes (adjusted odds ratio [AOR] =2.28; 95 percent confidence interval [Cl]=1.19, 4.34) and injection supplies (AOR= 3.23; 95 percent Cl=2.03, 5.13). These data suggest that decriminalizing syringes and needles would likely result in reductions in the behaviors that expose IDUs to blood borne viruses.

This study described the prevalence and risk factors for nonmedical prescription drug use (NMPD) among injection drug users (IDUs) recruited at syringe exchange programs (SEPs) in California. Interviews were conducted with 1,586 IDUs recruited from 24 SEPs across three annual cross-sections between 2001 and 2003. Any NMPD use in the past 6 months was reported by 17% of the sample. Factors independently associated with depressant use include recent participation in a drug treatment program, recent injection of heroin, and frequency of injection. Factors independently associated with opioid use include frequency of injection and history of incarceration. NMPD depressant use increased the odds of a nonfatal overdose in the past year. The authors' findings represent a first step toward creating an epidemiologic profile of NMPD use that may be useful for targeting the implementation of interventions that are effective in reducing overdoses, a significant cause of mortality among IDUs worldwide.

We examined whether gang membership history was associated with earlier age of first drug use, first drug injection, and shorter time to injection (TTI) drug use among people who inject drugs (PWID). PWID ( N = 438) were interviewed in California (2011-2013). Surveys addressed demographics, current/former drug use practices, gang membership, and parental drug use. Multivariate analyses were conducted to identify whether gang membership history was associated with age at first drug use, first injection drug use, and TTI. Gang membership was reported by 23% of sample. Gang membership history was associated with earlier ages of first drug use (–1.35 years; 95% confidence interval [CI]= [−0.50, −2.20]), age at first injection (–1.89 years; 95% CI = [0.00, −3.78]), but not TTI. Gang involvement facilitates drug use including earlier age of first injection drug use.

Legislation passed in 2000 allowed syringe exchange programs (SEPs) in California to operate legally if local jurisdictions declare a local HIV public health emergency. Nonetheless, even in locales where SEPs are legal, the possession of drug paraphernalia, including syringes, remained illegal. The objective of this paper is to examine the association between the legal status of SEPs and individual arrest or citation for drug paraphernalia among injection drug users (IDUs) in California from 2001 to 2003. Using data from three annual cross-sections (2001-03) of IDUs attending 24 SEPs in 16 California counties (N = 1,578), we found that overall, 14% of IDUs in our sample reported arrest or citation for paraphernalia in the 6 months before the interview. Further analysis found that 17% of IDUs attending a legal SEP (defined at the county level) reported arrest or citation for drug paraphernalia compared to 10% of IDUs attending an illegal SEP (p = 0.001). In multivariate analysis, the adjusted odds ratio of arrest or citation for drug paraphernalia was 1.6 [95% confidence interval (CI) = 1.2, 2.3] for IDUs attending legal SEPs compared to IDUs attending illegal SEPs, after controlling for race/ethnicity, age, homelessness, illegal income, injection of amphetamines, years of injection drug use, frequency of SEP use, and number of needles received at last visit. IDUs attending SEPs with legal status may be more visible to police, and hence, more subject to arrest or citation for paraphernalia. These findings suggest that legislative efforts to decriminalize the operation of SEPs without concurrent decriminalization of syringe possession may result in higher odds of arrest among SEP clients, with potentially deleterious implications for the health and well-being of IDUs. More comprehensive approaches to removing barriers to accessing sterile syringes are needed if our public health goals for reducing new HIV/HCV infections are to be obtained.

Drug related-soft tissue infections (DR-STIs) are a significant source of hospital utilization in inner-city urban areas where injection drug use is common but the magnitude of hospital utilization for DR-STIs outside of inner-city urban areas is not known. We described the magnitude and characteristics of hospital utilization for DR-STIs in urban versus rural counties in California. All discharges from all nonfederal hospitals in California in 2000 with ICD-9 codes for a soft tissue infection and for drug dependence/abuse were abstracted from the California Office of Statewide Health Planning and Development discharge database. There were 4,152 DR-STI discharges in 2000 from hospitals in 49 of California's 58 counties. Residents of 12 large metropolitan counties accounted for 3,598 discharges (87% of total). The majority of DR-STI discharges were from urban safety net hospitals with county indigent programs and Medicaid as the expected payment source and opiate related discharge diagnoses. Hospital utilization for DR-STIs in California is highest in large urban metropolitan counties, although DR-STI discharges are widespread. Increased access to harm reduction services and drug treatment may reduce government health care expenditures by preventing unnecessary hospital utilization for DR-STIs.