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Study Analyzes Risk Behavior and Syringe Coverage among participants accessing the IDEA Exchange

Public health researchers with the University of Miami Miller School of Medicine recently authored a study published in the International Journal of Drug Policy that provides important comparative data on the differences in demographic characteristics among users, risk behaviors, and syringe coverage among people who inject drugs.

The goal of the study was to provide policy considerations based on data from IDEA Exchange – the first legal syringe exchange program in the state of Florida – to show the importance of tailored prevention strategies, as well as to show the need for reform to the strict one-for-one syringe exchange policy at the state level.  

“When IDEA 2019 passed, which was the state law that passed last year that authorized syringe service programs across the state, the statute required strict one-for-one syringe exchange, which is not a best practice in the harm reduction community,” said lead study author Tyler Bartholomew, a Ph.D. candidate in Prevention Science and Community Health. “We also know that we serve many individuals that have different substance use behaviors, so this analysis really highlights who we are serving, how their risk behaviors may differ, and how well these classes of substance use are able to maintain syringe coverage, which is absolutely key to the prevention of infectious diseases.”

Injection drug use has been associated with the opioid crisis, as well as with driving increases in overdose, HIV, and Hepatitis C infections nationwide. In addressing this significant public health problem, syringe service programs have remained critical. Their overall goal is to provide as close to 100 percent syringe coverage as possible to protect against HIV and Hepatitis C infections, as well as with education to prevent overdoses, among other resources. 

Bartholomew and other UM co-authors of the study analyzed patterns of risk behavior and syringe coverage among 982 people who enrolled in the IDEA Exchange program between December 2016 to July 2019. Participants were classified into three groups, including those who injected heroin, methamphetamine, or who injected both heroin and cocaine. 

The study found that people who injected heroin and cocaine were more likely to report homelessness, sharing needles, unprotected sex, public injection, and to be Hepatitis C positive than those who injected heroin.

Compared to those who injected heroin and those who injected both heroin and cocaine, people who injected methamphetamine were more likely to be male, Hispanic, gay or bisexual orientation, HIV positive, to have unprotected sex, as well as sex with people who inject drugs.

Additionally, the study also found that the lowest and highest syringe coverage was among those in the heroin, cocaine and methamphetamine classes.  

These associations were analyzed using latent class analysis, an advanced research technique, which can help shed light on at-risk groups to inform syringe distribution policies and potential interventions.

The injection risk profiles and syringe coverage, for example, showed a variation between the three classes. This presented the potential need for targeted prevention strategies and for the increased need for reform at the state level.  

To mitigate infectious disease risk, existing interventions, such as syringe service programs, can be used to engage people who inject drugs from different populations. Researchers noted, however, that multi-component, targeted preventive interventions and need-based syringe distribution policies are required to further reduce HIV and HCV risk among various populations of people who inject drugs.       

“As we begin to roll out syringe service programs across the state, we need to change our service delivery policies in order to protect all people, and that will start with policy reform at the state level,” said Bartholomew.

Written by Amanda Torres
Published on March 24, 2020