Perceptions about supervised injection facilities among people who inject drugs in Philadelphia

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Abstract

Background

People who inject drugs (PWID) are at high risk for infectious diseases, skin and soft tissue infections, and overdose. However, these harms are all avoidable when sterile injection equipment, hygienic places to inject, and medical care are accessible. Unfortunately, many PWID in the U.S lack these resources. The most vulnerable are forced to inject in public spaces, where individual risks are high and communal harms are sometimes many. Supervised Injection Facilities (SIFs) are an established intervention for reducing these harms. Despite positive experiences in other countries, little research explores how PWID in the U.S. perceive the value of such facilities.

Methods

We conducted a freelisting exercise with PWID (n = 42) and healthcare providers (n = 20) at a syringe exchange program (SEP) that provides comprehensive clinical and social services in Philadelphia to inform in-depth semi-structured interviews with PWID (n = 19) at the same location.

Results

Participants expressed support for a potential SIF as a valuable public health intervention. They suggested that an SIF would improve PWID health while reducing the public disorder associated with injecting drugs in public. The latter was especially important to participants without stable housing, whose decision to inject furtively in secluded places was often motivated by desire not to upset community members, and particularly children. These participants acknowledged that such seclusion elevated the risk of fatal overdose. Despite similarly positive perceptions about an SIF, participants with stable housing reported that they would prefer to continue injecting at home.

Conclusion

Results both confirm and extend prior research about PWID and SIFs. Participants expressed support for SIFs as in prior survey research in the U.S. and in other countries. Facility location and housing status were identified as important determinants of facility use. Results extend prior research by illuminating PWID perceptions in the U.S. including motivations grounded in concern for public order.

Section snippets

Background

Injection drug use is a longstanding source of population harm. Despite considerable progress expanding harm reduction interventions, people who inject drugs (PWID) remain at high risk for infectious diseases such as HIV and hepatitis C (HCV) (Van Handel et al., 2016, Wejnert et al., 2016). Injection-related skin and soft tissue infections (SSTI) are common, and when medical care is delayed, costly and difficult to treat. With observed prevalence rates just over 30% among active PWID, these

Methods

Data collection began with a freelisting exercise with PWID (n = 42) and healthcare providers (n = 20), who were all recruited from a syringe exchange program (SEP) that provides clinical and social services in the Philadelphia area. Freelisting is an ethnographic tool used to explore individuals’ notions of health practices or conditions, and differences between healthcare providers and lay person’s perceptions. The approach identifies salient domains among people who have a shared experience,

Results

Qualitative interview participants identified as male (n = 9) and female (n = 10). Fifteen (n = 15) identified as White (n = 15); the remainder identified as Latino (n = 1), and Black (n = 3). Median age was 39 years (range: 27–59 years). Median time injecting drugs was 14 years (range: 2.5–20 years). Although not systematically elicited, in unstructured discussion, access to housing emerged as an important factor in participant decision-making and perceptions, with just over half of the participants

Discussion

Harm reduction services remain underfunded and unnecessarily impeded in many parts of the U.S. In places where syringe exchange is reasonably supported, there has been considerable progress in reducing the spread of disease. Most SEPs offer more services than just sterile syringes by providing counseling, naloxone kits and training, and a welcoming setting where PWID can connect with social and medical services. For many PWID, these services provide enough support to avoid or at least manage a

Conclusions

This study builds off previous work focused on the risk environment as experienced by PWID. As in past studies, our participants confirmed that social and environmental factors encourage high risk injection behaviors associated with infections and overdose. Our participants described being forced to sometimes or always inject in public spaces, which exposed them to risks that they understood and acknowledged, but could not avoid. The idea of a SIF was supported by PWID as a way to escape what

References (38)

  • C. Potier et al.

    Supervised injection services: What has been demonstrated? A systematic literature review

    Drug and Alcohol Dependence

    (2014)
  • W. Small et al.

    Public injection settings in Vancouver: Physical environment, social context and risk

    International Journal of Drug Policy

    (2007)
  • L. Ti et al.

    Police confrontations among street-involved youth in a Canadian setting

    International Journal of Drug Policy

    (2013)
  • E. Wood et al.

    Rationale for evaluating North America's first medically supervised safer-injecting facility

    Lancet Infectious Diseases

    (2004)
  • E. Wood et al.

    Do supervised injecting facilities attract higher-risk injection drug users?

    American Journal of Preventive Medicine

    (2005)
  • I.A. Binswanger et al.

    Drug users seeking emergency care for soft tissue infection at high risk for subsequent hospitalization and death

    Journal of Studies on Alcohol and Drugs

    (2008)
  • R.N. Bluthenthal et al.

    The effect of syringe exchange use on high-risk injection drug users: A cohort study

    AIDS

    (2000)
  • B.A. Bouvier et al.

    Willingness to use a supervised injection facility among young adults who use prescription opioids non-medically: A cross-sectional study

    Harm Reduction Journal

    (2017)
  • P. Braitstein et al.

    Sexual violence among a cohort of injection drug users

    Social Science & Medicine

    (1982)
  • Cited by (0)

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