Women Who Inject Drugs at the Uniting Sydney Medically Supervised Injecting Centre: Twenty-Year Trends in Service Access and Non-Fatal Overdose.


Author: Amanda Roxburgh, Marianne Jauncey, Mark Bartlett, Carolyn Day, Suzanne Nielsen, Julie Latimer, Paul Dietze

Theme: Epidemiology & Public Health Research Year: 2023

Background:
International research shows women who inject drugs experience significantly higher drug-related harms including greater rates of risky injecting practices and higher rates of HIV than men. Supervised injecting facilities (SIFs), designed to reduce these risks, are traditionally male-dominated environments. Little is known about how women access SIFs and whether there are differences in drugs injected and overdose rates. The current study present patterns of injecting and overdose onsite among women accessing the Sydney Medically Supervised Injecting Centre (MSIC).

Methods:
Retrospective analysis of quarterly visits stratified by drugs injected at the MSIC, 2001-2021. Rates of quarterly opioid overdoses per 100 opioid injecting visits.

Results:
Women made up a quarter of the clients attending MSIC during the period. Visits predominantly involved opioids (between 49-90% of all female visits), changing from heroin (range 42%-83%) to pharmaceutical opioids (range 46%-69%) between 2009-2014, returning to heroin (range 36%-57%) between 2015-2021. An increasing proportion of visits involved methamphetamine injecting (13% in 2014/Q1 to 48% in 2021/Q2), outnumbering those for heroin (41% in 2021/Q2). Opioid overdose rates doubled between 2001-2017 (from 1.5 to 3.8) declining to 1.4 in 2021/Q2. In comparison, a larger proportion of male visits were for methamphetamine (52%) in 2021/Q2, with heroin comprising 32%. Almost double the proportion of male visits (15% in 2021/Q2) were for pharmaceutical opioids compared to 9% of female visits. Interestingly, rates/trends of overdose were similar among males and females until 2018/Q3 when overdoses among males continued to increase.

Conclusion:
Early analysis shows nuanced differences in drugs women inject at the MSIC, with greater proportions of visits for heroin, and fewer for pharmaceutical opioids. Overdose rates were strikingly similar for women and men. Further understanding of the clinical profiles and whether overdose risks change over time among women will prove important in delivering targeted services that are more responsive to the needs of women attending the MSIC.

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