The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #61593

Jennifer McNeely¹, Julia H. Arnsten, MD, MPH¹, Alison Karasz, PhD², and Marc N. Gourevitch, MD, MPH¹. (1) Division of Substance Abuse, Albert Einstein College of Medicine and Montefiore Medical Center, 1500 Waters Place, Bronx, NY 10461, (718)409-9450, jmcneely@aecom.yu.edu, (2) Department of Family Medicine and Community Health, Montefiore Medical Center, 3544 Jerome Avenue, Bronx, NY 10467

BACKGROUND: Though access to sterile syringes is an important public health intervention for injection drug users, substantial barriers persist. The Expanded Syringe Access Program (ESAP), recently enacted in New York State, permits non-prescription syringe sales by participating pharmacies. However, the uptake of such harm reduction initiatives by patients and providers in drug treatment settings remains unclear. METHODS: Interviews with 127 consecutive new entrants in a methadone maintenance treatment (MMT) program gathered information about injection practices and syringe acquisition and disposal. Qualitative and quantitative interviews with clinical staff assessed current treatment practices, knowledge, and attitudes. RESULTS: Patients were 59% male, age (mean) 39, with HIV and HCV rates of 21% and 43%, respectively. Most (60%) had a history of drug injection. Of the 41 (32%) current injectors, 51% reported using a needle exchange, and 49% bought syringes on the street. 44% of current injectors knew about ESAP. Of those (42%) attempting to buy syringes in a pharmacy, 48% were refused sale. The most common (60%) means of disposing of syringes was the regular trash, followed by return to a needle exchange (41%), and toilet/sewer (20%). Staff interviews revealed that counseling patients on obtaining sterile syringes is not common treatment practice due to lack of knowledge, fear that it conveys acceptance of ongoing drug use, and concerns about community relations. CONCLUSION: Utilization of sanctioned venues for safely obtaining and disposing injection equipment by new MMT entrants is inadequate. An intervention to increase their use is currently being implemented in our MMT program.

Learning Objectives:

• At the conclusion of the session, the participant will be able to:
• 1. Recognize the prevalence of injection drug use among new entrants to drug treatment and identify sources of injecting equipment utilized by this population.
• 2. Describe the ways in which injection drug users dispose of used injecting equipment, assess barriers to safe disposal, and develop interventions to encourage proper means of disposal.
• 3. Understand the current state of knowledge and attitudes of drug treatment staff regarding harm reduction, and apply it in developing appropriate staff training and other interventions aimed at integrating harm reduction approaches into drug treatment settings.

Keywords: Drug Abuse Treatment, Drug Injectors

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.