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PREVENTING OVERDOSE DEATHS AND THE SPREAD OF BLOOD-BORNE DISEASES AMONG INJECTION DRUG USERS: THE CASE FOR SAFER INJECTING ROOMS
Evan Wood, Tyndall MW, Spittal PM, Li K, Hogg RS, Montaner JS, O’Shaughnessy MV, Schechter MT
British Columbia Centre for Excellence in HIV/AIDS/Department of Health Care and Epidemiology, University of British Columbia
Objectives: In Vancouver, neither the protective effect of needle exchange nor targeted law enforcement have been sufficient to prevented injection-related HIV and overdose epidemics. In Europe, legally sanctioned and supervised facilities where addicts can inject preobtained drugs, have reduced these, and the public disorder problems of drugs. We explored aspects of Vancouver’s drug problem that could potentially be alleviated by the establishment of safer injection rooms (SIRs).
Methods: These analyses were restricted to the 779 participants in the VIDUS cohort who reported actively injecting drugs at their most recent follow-up, during the period January 1999 to October 2000. Needle sharing was defined as either borrowing or lending a used needle in the prior six months.
Results: Overall, 214 (28%) of participants reported sharing a needle during the last six months. In a multivariate analysis, requiring help injection (OR=2.0), difficulty accessing clean needles (OR=2.7) and needle reuse (OR=1.8) were associated with sharing, as were frequent cocaine and heroin injection (OR=1.6 and 1.5 respectively). During the last six months, 10% of participants reported a nonfatal overdose, a behaviour that was also associated with sharing (OR=1.7); as was being refused needles at pharmacies (OR=2.0). In addition, 14% of participants injected outdoors, 75% reported injecting alone – a primary risk factor for overdosing – and 46% reported unsafe needle disposal. We also found trends suggesting that police pressure may be associated with needle sharing.
Conclusions: In Europe, and more recently in Australia, the establishment of SIRs has improved access to sterile needles, prevented needle sharing and reuse, and reduced public injection, unsafe needle disposal, and overdose deaths. Given the nature of the health and public order problems presently occurring in our setting, it is urgent to evaluate if the experience with SIRs can be replicated in Canada.