Emerging Risks Due to New Injecting Patterns in Hungary During Austerity Times.

As a consequence of the massive restructuring of drug availability, heroin injection in Hungary was largely replaced by the injecting of new psychoactive substances (NPS) starting in 2010. In the following years in our sero-prevalence studies we documented higher levels of injecting paraphernalia sharing, daily injection-times, syringe reuse, and HCV prevalence among stimulant injectors, especially among NPS injectors. Despite the increasing demand, in 2012 the number of syringes distributed dropped by 35% due to austerity measures. Effects of drug market changes and the economic recession may have future epidemiological consequences. Study limitations are noted and future needed research is suggested.

Individual-level syringe coverage among Needle and Syringe Program attendees in Australia.

BACKGROUND: Harm associated with injecting drug use is a significant public health issue and a major cause of morbidity and mortality, with global estimates of 3 million injectors infected with HIV and 8 million living with chronic hepatitis C virus (HCV) infection. Estimates of program coverage are widely used in the context of HIV prevention and are critical in determining the effectiveness of interventions such as Needle and Syringe Programs (NSPs). METHODS: Data from a national cross-sectional study of NSP attendees in Australia were used to estimate individual-level syringe coverage as a proportion of monthly injections covered by a new syringe. Univariate and multivariate logistic regressions modelled associations between demographics, injecting risk, anti-HIV and HCV prevalence and syringe coverage. The median number of syringes retained per NSP attendee per annum was also estimated. RESULTS: Twenty percent of participants had insufficient new syringes for all injections. Syringe reuse (including reuse of one's own syringe) was independently associated with syringe coverage of <100%. Conversely, procurement of syringes from an NSP was independently associated with syringe coverage ≥100%, with a greater protective effect occurring when NSP utilisation was combined with current engagement in opiate substitution therapy. The median number of syringes retained per participant per annum was 720, equivalent to 2 per day. CONCLUSIONS: While Australian NSP attendees report high syringe coverage by international standards, prevention efforts could be scaled up. Syringe reuse was associated with syringe coverage of <100%, suggesting the utility of reuse as a proxy for individual-level syringe coverage.

Trends in injection drug use behaviors over 10 years among street youth.

OBJECTIVES: To determine the temporal trends of initiation into injection drug use, current injection, and recent receptive sharing of injection paraphernalia among street youth. DESIGN: Data from two cohort studies conducted between 1995 and 2005 were combined. METHODS: Recruitment was done on an ongoing basis. Interviews were performed semi-annually. Overall and annual drug injection incidence rates were calculated with the person-time method. Poisson regression was used to assess the predictive power of calendar year on incidence rate. Generalized estimating equations (GEE) were used to assess linear trends in current injection among street youth and in recent receptive sharing of syringe and other injection paraphernalia among current injection drug users. RESULTS: By 31 March 2005, 1633 subjects had completed 8875 questionnaires. Most subjects were born in Canada (94%), their mean age at entry was 20 years, 68% were boys and almost half (44%) had injected drugs before recruitment. Among 778 never injectors at entry, 130 subjects initiated injection in 1898 person-years of follow-up (incidence rate: 6.8 per 100 person-years). When controlling for age, calendar year was not a significant predictor of incidence rate. Prevalence of current injection was stable (around 30%). Odds of both sharing behaviors decreased by approximately 10% per year. CONCLUSIONS: In addition to injection paraphernalia sharing reduction efforts, interventions aimed at preventing initiation into injection drug use among high-risk youth are needed.

Attendance, drug use patterns, and referrals made from North America's first supervised injection facility.

BACKGROUND: North America's first government sanctioned supervised injection facility (SIF) was opened in Vancouver in response to the serious health and social consequences of injection drug use and the perseverance of committed advocates and drug user groups who demanded change. This analysis was conducted to describe the attendance, demographic characteristics, drug use patterns, and referrals made during the first 18 months of operation. METHODS: As part of the evaluation strategy for the SIF, information is collected through a comprehensive on-site database designed to track attendance and the daily activities within the facility. All users of the SIF must sign a waiver form and are then entered into a database using a unique identifier of their choice. This identifier is used at each subsequent visit to provide a prospective record of attendance, drug use, and interventions. RESULTS: From 10 March 2004 to 30 April 2005 inclusive, there were 4764 unique individuals who registered at the SIF. The facility successfully attracted a range of community injection drug users including women (23%) and members of the Aboriginal community (18%). Although heroin was used in 46% of all injections, cocaine was injected 37% of the time. There were 273 witnessed overdoses with no fatalities. During just 12 months of observation, 2171 individual referrals were made with the majority (37%) being referred for addiction counseling. INTERPRETATION: Vancouver's SIF has successfully been integrated into the community, has attracted a wide cross section of community injection drug users, has intervened in overdoses, and initiated over 2000 referrals to counseling and other support services. These findings should be useful for other settings considering SIF trials.