Syringe Re-Use Among People Who Inject Drugs In Rural Appalachia

Author: Grayson Fuller Laura Fanucchi Hannah Cooper Grayson Fuller

Theme: Epidemiology & Public Health Research Year: 2022

Injection-related bacterial and fungal infections can lead to serious conditions including infective
endocarditis, osteomyelitis, epidural abscesses, and sepsis. Syringe reuse by people who inject drugs
(PWID) could increase risk for these infections. Yet, few studies have explored syringe reuse,
particularly in rural settings where access to a clean syringe for each injection may be reduced by
limited harm reduction infrastructure. This study describes syringe reuse among PWID in rural
Appalachian Kentucky, an area that has been an epicenter of drug-related harms.
PWID (n=238) completed interviewer-administered questionnaires that elicited data on syringe
reuse (average number of times they use each of their syringes), behavioral and demographic
characteristics, and syringe service program (SSP) access. Negative log binomial regression was used
to examine factors associated with syringe reuse.
On average, people used each syringe nine times (median: 3; IQR: 2-10). Syringe re-use was higher
among men [aOR=1.39; 95% CI: 1.04-1.85] and those who injected more frequently, injected
buprenorphine [aOR=1.46; 95% CI: 1.10-1.95] and methamphetamine [aOR=2.12; 95% CI: 1.45-3.12],
engaged in receptive syringe sharing [aOR=1.76; 95% CI: 1.30-2.38], and reported a higher syringe
street price [aOR=2.36; 95% CI: 1.51-3.59]. Syringe re-use was also higher among those who lived
greater than 30 minutes from an SSP [aOR=2.35; 95% CI: 1.43-3.87].
Rural PWID are re-using syringes nine times on average conferring extensive risk for contamination
between injections and thereby heightening risk of injection-related infections. Further, syringe reuse was higher among those engaging in receptive syringe sharing, indicating that syringes might be
reused more times than reported and could carry risk for hepatitis C as well. Ensuring that SSPs are
easily accessible to rural PWID who may lack transportation might reduce syringe reuse. Harm
reduction interventions that encourage syringe cleaning may be warranted as a stop-gap measure
while SSP reach is expanded.
Disclosure of Interest Statement:
The authors have no conflicts of interest.

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