Safe and unsafe spaces: Non-fatal overdose, arrest, and receptive syringe sharing among people who inject drugs in public and semi-public spaces in Baltimore City

Abstract Background Drug use is a growing concern in Ghana. People who inject drugs (PWID) are highly vulnerable to HIV and other infectious diseases. Ghana’s National Strategic Plan for HIV/AIDS 2016–2020 identifies PWID as a key population, but efforts to address the needs of PWID have lagged behind those targeting sex workers and men who have sex with men. Lack of information about PWID is a critical barrier to implementing effective HIV prevention and treatment. We aimed to learn more about the vulnerability of the PWID population in order to inform much-needed harm reduction interventions. Methods From April to July 2018, we conducted a mixed methods study in Kumasi, Ghana, to identify all major drug using locations, count the numbers of PWID to obtain rough population size estimations, and administer anonymous surveys to 221 PWID regarding drug use and sexual behavior. We also tested for HIV, HCV, and HBV from syringes used by survey participants. Results Key informants identified five major drug using locations and estimated the total PWID population size to be between 600 and 2000. Enumerators counted between 35 and 61 individuals present at each of the five bases. Sharing syringes and reusing discarded syringes are common practices. Over half of survey participants (59%) reported past-month syringe sharing (34% used a used syringe and 52% gave away a used syringe). Individuals with higher injection frequency (≥ 21 times weekly) and who injected with four or more people had higher odds of syringe sharing. Of the survey participants reporting sex in the last month (23%), most reported having one partner, but only 12% used condoms. Nearly all women (11/13) reported exchanging sex for drugs and 6/13 reported exchanging sex for money in the last six months. Fifteen percent of participants (all men) reported paying for sex using drugs or money. Of the used syringes, prevalence estimates were 3% (HIV), 2% (HCV), and 9% (HBV). Conclusions Our findings confirm the urgent need to implement harm reduction interventions targeting PWID and to build a strong and enabling legal and policy environment in Ghana to support these efforts.

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Risk of non‐fatal overdose and polysubstance use in a longitudinal study with people who inject drugs in Tijuana, Mexico

Drug and Alcohol Review ◽

10.1111/dar.13305 ◽

2021 ◽

Author(s):

Carlos D. Rivera Saldana ◽

Daniela Abramovitz ◽

Meredith C. Meacham ◽

Patricia Gonzalez‐Zuniga ◽

Claudia Rafful ◽

...

Keyword(s):

Longitudinal Study ◽

People Who Inject Drugs ◽

Polysubstance Use ◽

Fatal Overdose

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No association between HIV status and risk of non-fatal overdose among people who inject drugs in Vancouver, Canada

Addictive Behaviors ◽

10.1016/j.addbeh.2016.03.029 ◽

2016 ◽

Vol 60 ◽

pp. 8-12 ◽

Cited By ~ 4

Author(s):

Daniel J. Escudero ◽

Brandon D.L. Marshall ◽

Thomas Kerr ◽

Kanna Hayashi ◽

Cindy Feng ◽

...

Keyword(s):

People Who Inject Drugs ◽

Hiv Status ◽

Fatal Overdose

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Fatal overdose prevention and experience with naloxone: A cross-sectional study from a community-based cohort of people who inject drugs in Baltimore, Maryland

PLoS ONE ◽

10.1371/journal.pone.0230127 ◽

2020 ◽

Vol 15 (3) ◽

pp. e0230127

Author(s):

Megan Buresh ◽

Rachel E. Gicquelais ◽

Jacquie Astemborski ◽

Gregory D. Kirk ◽

Shruti H. Mehta ◽

...

Keyword(s):

People Who Inject Drugs ◽

Cross Sectional Study ◽

Sectional Study ◽

Community Based ◽

Cross Sectional ◽

Overdose Prevention ◽

Fatal Overdose

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The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis

International Journal of Drug Policy ◽

10.1016/j.drugpo.2019.07.030 ◽

2019 ◽

Vol 73 ◽

pp. 172-184 ◽

Cited By ~ 8

Author(s):

Samantha Colledge ◽

Amy Peacock ◽

Janni Leung ◽

Sarah Larney ◽

Jason Grebely ◽

...

Keyword(s):

Systematic Review ◽

People Who Inject Drugs ◽

Meta Analysis ◽

Fatal Overdose ◽

Multi Stage

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Non -fatal overdose among people who inject drugs in Tehran, Iran

Substance Abuse Treatment Prevention and Policy ◽

10.1186/s13011-020-00323-0 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Mehdi Noroozi ◽

Peter Higgs ◽

Azadeh Bayani ◽

Bahram Armoon ◽

Ali Nazeri Astaneh ◽

...

Keyword(s):

Risk Factors ◽

Drug Use ◽

People Who Inject Drugs ◽

Statistical Significance ◽

Cross Sectional Survey ◽

The Past ◽

Fatal Overdose ◽

Increased Risk ◽

Associated Risk Factors ◽

Multiple Drugs

Abstract Background With increasing frequencies of non-fatal overdose in people who inject drugs (PWID), it is essential to improve our knowledge about associated risk factors for overdose to inform overdose prevention and assistance programs. The aim of present study was to determine the prevalence of non-fatal overdose and the associated risk factors among PWID in Tehran, Iran. Methods Snowball sampling was used to collect data from 465 participants in Tehran using a cross-sectional survey. Consenting participants who reported drug injecting in the past month and were able to speak and comprehend Farsi enough to respond to survey questions were interviewed. The endpoint of interest was non-fatal overdose in the previous 6 months, or answering “Yes” to the question: “In the last six months, have you ever overdosed by accident? (at least once)”. We used STATA v. 14 for this analysis. Statistical significance was defined as p < 0.05 for all analyses. Results Of 465 PWIDs who participated in this study, all were male, and about half had less than a high school education. The prevalence of self-reported non-fatal overdose in the past 6 months was 38% (CI95%: 34, 43%). Our findings indicate that characteristics and behaviors that were associated with an increased risk of experiencing an overdose in the past 6 months were drug use initiation under 22 years (AOR =2.2, P < 0.05), using methamphetamine (AOR =2.8, P < 0.05), and using multiple drugs at the same time (AOR =2.1, P < 0.05). Also, more recent initiates to injecting (< 2 years) had an increased risk of experiencing an overdose in the past 6 months. The odds of experiencing a non-fatal overdose among PWIDs who regularly attended NSP were 0.6 times less than for those who did not attend regularly (OR = 0.6,95% CI: 0.2–0.9). Conclusion Methamphetamine and alcohol use were the most significant association for non-fatal overdose among PWIDs. Our results indicate that intervention and prevention initiatives seeking to reduce overdoses among PWIDs should not only be focused on the primary drug used but also the use of alcohol and poly-drug use.

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