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Ricky N. Bluthenthal - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and predictors of transitions to and away from syringe exchange use over time in 3 US cities with varied syringe dispensing policies.
Drug and Alcohol Dependence, 2010Co-Authors: Traci C. Green, Ricky N. Bluthenthal, Merrill Singer, Leo Beletsky, Lauretta E. Grau, Patricia A. Marshall, Robert HeimerAbstract:Syringe exchange programs (SEPs) can reduce HIV risk among injecting Drug users (IDUs) but their use may depend heavily on contextual factors such as local syringe policies. The frequency and predictors of transitioning over time to and from direct, indirect, and non-use of SEPs are unknown. We sought, over one year, to: (1) quantify and characterize transition probabilities of SEP attendance typologies; (2) identify factors associated with (a) change in typology, and (b) becoming and maintaining Direct SEP use; and (3) quantify and characterize transition probabilities of SEP attendance before and after changes in policy designed to increase access. Using data collected from 583 IDUs participating in a three-city cohort study of SEPs, we conducted a latent transition analysis and multinomial regressions. Three typologies were detected: Direct SEP users, Indirect SEP users and Isolated IDUs. Transitions to Direct SEP use were most prevalent. Factors associated with becoming or maintaining Direct SEP use were female sex, Latino ethnicity, fewer injections per syringe, homelessness, recruitment city, injecting speedballs (cocaine and heroin), and police contact involving Drug Paraphernalia possession. Similar factors influenced transitions in the syringe policy change analysis. Policy change cities experienced an increase in Indirect SEP users (43-51%) with little increased direct use (29-31%). We found that, over time, IDUs tended to become Direct SEP users. Policies improving syringe availability influenced SEP use by increasing secondary syringe exchange. Interactions with police around Drug Paraphernalia may encourage SEP use for some IDUs and may provide opportunities for other health interventions.
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The impact of legalizing syringe exchange programs on arrests among injection Drug users in California.
Journal of urban health : bulletin of the New York Academy of Medicine, 2007Co-Authors: Alexis N. Martinez, Ricky N. Bluthenthal, Jennifer Lorvick, Rachel Anderson, Neil M. Flynn, Alex H. KralAbstract:Legislation passed in 2000 allowed syringe exchange programs (SEPs) in California to operate legally if local jurisdictions declare a local HIV public health emergency. Nonetheless, even in locales where SEPs are legal, the possession of Drug Paraphernalia, including syringes, remained illegal. The objective of this paper is to examine the association between the legal status of SEPs and individual arrest or citation for Drug Paraphernalia among injection Drug users (IDUs) in California from 2001 to 2003. Using data from three annual cross-sections (2001-03) of IDUs attending 24 SEPs in 16 California counties (N = 1,578), we found that overall, 14% of IDUs in our sample reported arrest or citation for Paraphernalia in the 6 months before the interview. Further analysis found that 17% of IDUs attending a legal SEP (defined at the county level) reported arrest or citation for Drug Paraphernalia compared to 10% of IDUs attending an illegal SEP (p = 0.001). In multivariate analysis, the adjusted odds ratio of arrest or citation for Drug Paraphernalia was 1.6 [95% confidence interval (CI) = 1.2, 2.3] for IDUs attending legal SEPs compared to IDUs attending illegal SEPs, after controlling for race/ethnicity, age, homelessness, illegal income, injection of amphetamines, years of injection Drug use, frequency of SEP use, and number of needles received at last visit. IDUs attending SEPs with legal status may be more visible to police, and hence, more subject to arrest or citation for Paraphernalia. These findings suggest that legislative efforts to decriminalize the operation of SEPs without concurrent decriminalization of syringe possession may result in higher odds of arrest among SEP clients, with potentially deleterious implications for the health and well-being of IDUs. More comprehensive approaches to removing barriers to accessing sterile syringes are needed if our public health goals for reducing new HIV/HCV infections are to be obtained.
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Drug Paraphernalia Laws and Injection-Related Infectious Disease Risk among Drug Injectors
Journal of Drug Issues, 1999Co-Authors: Ricky N. Bluthenthal, Alex H. Kral, Elizabeth A. Erringer, Brian R. EdlinAbstract:Drug Paraphernalia laws in 47 U.S. states make it illegal for injection Drug users (IDUs) to possess syringes. It has been suggested that these laws lead to syringe sharing by deterring IDUs from carrying their own syringes. We examined the relationship between concern about arrest while carrying Drug Paraphernalia and injection-related risk behaviors among street-recruited IDUs in Northern California. In 1996, 424 IDUs were interviewed, of whom 76 percent were African American, 36 percent were female, and 15 percent were HIV positive. Thirty-five percent (150) reported concern about being arrested while carrying Drug Paraphernalia. In multivariate analyses that controlled for potential confounders, IDUs concerned about being arrested were significantly more likely than other IDUs to share syringes (adjusted odds ratio [AOR] =2.28; 95 percent confidence interval [Cl]=1.19, 4.34) and injection supplies (AOR= 3.23; 95 percent Cl=2.03, 5.13). These data suggest that decriminalizing syringes and needles would...
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Collateral Damage in the War on Drugs: HIV Risk Among Injection Drug Users
1999Co-Authors: Ricky N. Bluthenthal, Alex H. Kral, Elizabeth A. Erringer, Jennifer Lorvick, James G. KahnAbstract:IDUs were interviewed regarding HIV risk behaviors, Drug use, and criminal activities in six San Francisco Bay Area communities in 1996 and followed through 1997 (n = 1257). Multivariate analysis was conducted to examine the association between concern about arrest while carrying Drug Paraphernalia and injection-related risk behaviors.
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Collateral damage in the war on Drugs: HIV risk behaviors among injection Drug users
International Journal of Drug Policy, 1999Co-Authors: Ricky N. Bluthenthal, Alex H. Kral, Elizabeth A. Erringer, Jennifer Lorvick, James G. KahnAbstract:Abstract Objective: To determine whether two key War on Drugs policies, the criminalization of syringes and the disqualification of Drug users from the Supplemental Security Income (SSI) program, are associated with injection-related human immunodeficiency virus (HIV) risk behaviors among injection Drug users (IDUs). Methods: IDUs were interviewed regarding HIV risk behaviors, Drug use, and criminal activities in six San Francisco Bay Area communities in 1996 and followed through 1997 ( n =1257). Multivariate analysis was conducted to examine the association between concern about arrest while carrying Drug Paraphernalia and injection-related risk behaviors. Regarding SSI, respondents were interviewed before (1996) and after (1997) Drug and alcohol addicts were disqualified from SSI ( n =88). Bivariate analysis was conducted comparing IDUs who lost SSI benefits with those who retained benefits. Results: Among our study sample, 32% of IDUs reported being concerned about possible arrest while carrying Drug Paraphernalia. In multivariate analysis, concerned IDUs were over one-and-a-half times more likely to share syringes than IDUs not concerned (adjusted odds ratio=1.74; 95% confidence interval=1.24, 2.44). Regarding SSI, 60% (53/88) of baseline SSI recipients had lost benefits by their follow-up interview. IDUs who lost benefits were more likely to participate in illegal activities (48 vs. 27%; P P P
Samuel R. Friedman - One of the best experts on this subject based on the ideXlab platform.
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A New Generation of Drug Users in St. Petersburg, Russia? HIV, HCV, and Overdose Risks in a Mixed-Methods Pilot Study of Young Hard Drug Users.
AIDS and behavior, 2019Co-Authors: Peter Meylakhs, Samuel R. Friedman, Anastasia Y. Meylakhs, Pedro Mateu-gelabert, Danielle C. Ompad, Alisa Alieva, Alexandra DmitrievaAbstract:Russia has a widespread injection Drug use epidemic with high prevalence of HIV and HCV among people who inject Drugs (PWID). We conducted a mixed methods study of young (age 18–26) hard Drug users in St. Petersburg. Thirty-nine structured and 10 semi-structured interviews were conducted. No HIV cases and two HCV cases were detected among the PWID subsample (n = 29). Amphetamine and other stimulants were common (70%), opioid use was rare and episodic. Consistent condom use was 10%. No PWID reported syringe-sharing, 51% reported other Drug Paraphernalia sharing. Most (89%) never or rarely communicated with older (30 +) opiate users. A new cohort of Drug users in St. Petersburg may have emerged, which is much safer in its injection practices compared to previous cohorts. However, risky sexual practices among this new cohort may expose them to the possibility of sexual transmission of HIV and widespread Drug Paraphernalia sharing to the HCV epidemic.
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The Tacoma Syringe Exchange
Journal of Addictive Diseases, 1991Co-Authors: Holly Hagan, Don C. Des Jarlais, David Purchase, Terry Reid, Samuel R. FriedmanAbstract:For over a year, the Tacoma Syringe Exchange has been operating in spite of existing Drug Paraphernalia laws. One hundred fifty-four subjects have been interviewed regarding Drug injection practices for the month prior to first use of the exchange and for the most recent month since using the exchange. Statistically significant reductions in mean frequency of obtaining used syringes, and in mean rate of passing on used syringes, have been reported. Mean number of times bleach was used to disinfect contaminated syringes has risen. The exchange continues to attract mainly men, median age 35, with a long history of injection. No differences have been observed in mean number of injections per month. In order to increase utilization, new sites are planned, but expansion has been hampered by a series of legal problems. Since the exchange draws many difficult to reach individuals, it is an important location for STD screening and Drug treatment recruitment. Documentation of participation patterns and barriers to...
Alex H. Kral - One of the best experts on this subject based on the ideXlab platform.
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The impact of legalizing syringe exchange programs on arrests among injection Drug users in California.
Journal of urban health : bulletin of the New York Academy of Medicine, 2007Co-Authors: Alexis N. Martinez, Ricky N. Bluthenthal, Jennifer Lorvick, Rachel Anderson, Neil M. Flynn, Alex H. KralAbstract:Legislation passed in 2000 allowed syringe exchange programs (SEPs) in California to operate legally if local jurisdictions declare a local HIV public health emergency. Nonetheless, even in locales where SEPs are legal, the possession of Drug Paraphernalia, including syringes, remained illegal. The objective of this paper is to examine the association between the legal status of SEPs and individual arrest or citation for Drug Paraphernalia among injection Drug users (IDUs) in California from 2001 to 2003. Using data from three annual cross-sections (2001-03) of IDUs attending 24 SEPs in 16 California counties (N = 1,578), we found that overall, 14% of IDUs in our sample reported arrest or citation for Paraphernalia in the 6 months before the interview. Further analysis found that 17% of IDUs attending a legal SEP (defined at the county level) reported arrest or citation for Drug Paraphernalia compared to 10% of IDUs attending an illegal SEP (p = 0.001). In multivariate analysis, the adjusted odds ratio of arrest or citation for Drug Paraphernalia was 1.6 [95% confidence interval (CI) = 1.2, 2.3] for IDUs attending legal SEPs compared to IDUs attending illegal SEPs, after controlling for race/ethnicity, age, homelessness, illegal income, injection of amphetamines, years of injection Drug use, frequency of SEP use, and number of needles received at last visit. IDUs attending SEPs with legal status may be more visible to police, and hence, more subject to arrest or citation for Paraphernalia. These findings suggest that legislative efforts to decriminalize the operation of SEPs without concurrent decriminalization of syringe possession may result in higher odds of arrest among SEP clients, with potentially deleterious implications for the health and well-being of IDUs. More comprehensive approaches to removing barriers to accessing sterile syringes are needed if our public health goals for reducing new HIV/HCV infections are to be obtained.
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Drug Paraphernalia Laws and Injection-Related Infectious Disease Risk among Drug Injectors
Journal of Drug Issues, 1999Co-Authors: Ricky N. Bluthenthal, Alex H. Kral, Elizabeth A. Erringer, Brian R. EdlinAbstract:Drug Paraphernalia laws in 47 U.S. states make it illegal for injection Drug users (IDUs) to possess syringes. It has been suggested that these laws lead to syringe sharing by deterring IDUs from carrying their own syringes. We examined the relationship between concern about arrest while carrying Drug Paraphernalia and injection-related risk behaviors among street-recruited IDUs in Northern California. In 1996, 424 IDUs were interviewed, of whom 76 percent were African American, 36 percent were female, and 15 percent were HIV positive. Thirty-five percent (150) reported concern about being arrested while carrying Drug Paraphernalia. In multivariate analyses that controlled for potential confounders, IDUs concerned about being arrested were significantly more likely than other IDUs to share syringes (adjusted odds ratio [AOR] =2.28; 95 percent confidence interval [Cl]=1.19, 4.34) and injection supplies (AOR= 3.23; 95 percent Cl=2.03, 5.13). These data suggest that decriminalizing syringes and needles would...
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Collateral Damage in the War on Drugs: HIV Risk Among Injection Drug Users
1999Co-Authors: Ricky N. Bluthenthal, Alex H. Kral, Elizabeth A. Erringer, Jennifer Lorvick, James G. KahnAbstract:IDUs were interviewed regarding HIV risk behaviors, Drug use, and criminal activities in six San Francisco Bay Area communities in 1996 and followed through 1997 (n = 1257). Multivariate analysis was conducted to examine the association between concern about arrest while carrying Drug Paraphernalia and injection-related risk behaviors.
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Collateral damage in the war on Drugs: HIV risk behaviors among injection Drug users
International Journal of Drug Policy, 1999Co-Authors: Ricky N. Bluthenthal, Alex H. Kral, Elizabeth A. Erringer, Jennifer Lorvick, James G. KahnAbstract:Abstract Objective: To determine whether two key War on Drugs policies, the criminalization of syringes and the disqualification of Drug users from the Supplemental Security Income (SSI) program, are associated with injection-related human immunodeficiency virus (HIV) risk behaviors among injection Drug users (IDUs). Methods: IDUs were interviewed regarding HIV risk behaviors, Drug use, and criminal activities in six San Francisco Bay Area communities in 1996 and followed through 1997 ( n =1257). Multivariate analysis was conducted to examine the association between concern about arrest while carrying Drug Paraphernalia and injection-related risk behaviors. Regarding SSI, respondents were interviewed before (1996) and after (1997) Drug and alcohol addicts were disqualified from SSI ( n =88). Bivariate analysis was conducted comparing IDUs who lost SSI benefits with those who retained benefits. Results: Among our study sample, 32% of IDUs reported being concerned about possible arrest while carrying Drug Paraphernalia. In multivariate analysis, concerned IDUs were over one-and-a-half times more likely to share syringes than IDUs not concerned (adjusted odds ratio=1.74; 95% confidence interval=1.24, 2.44). Regarding SSI, 60% (53/88) of baseline SSI recipients had lost benefits by their follow-up interview. IDUs who lost benefits were more likely to participate in illegal activities (48 vs. 27%; P P P
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Impact of law enforcement on syringe exchange programs: A look at Oakland and San Francisco
Medical anthropology, 1997Co-Authors: Ricky N. Bluthenthal, Alex H. Kral, Jennifer Lorvick, John K. WattersAbstract:Drug Paraphernalia and prescription laws make syringe exchange programs @SEPs@ illegal in most states in the U.S. Nonetheless, SEPs have been started in 25 states and the District of Columbia as of September 1995. In some states like California and New Jersey, SEPs have operated despite police arrest of volunteers and clients. We examine the impact of police action and threat on SEPs by comparing an underground syringe exchange site @SES) in West Oakland to a tolerated SES in the Fillmore neighborhood of San Francisco. The following data sources are utilized: demographic and service utilization data from Alameda County Exchange (ACE) in West Oakland and Prevention Point Needle and Syringe Exchange (PPNSE) in the Fillmore, San Francisco; demographic and syringe exchange utilization information collected from street‐recruited samples of injection Drug users (IDUs) in West Oakland and the Fillmore; and participant observation of SES in these two communities. We found that police action and the threat of poli...
Michael A. Purdy - One of the best experts on this subject based on the ideXlab platform.
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Hepatitis A Virus Survival on Drug Paraphernalia
Infection Control & Hospital Epidemiology, 2020Co-Authors: Magdalena Medrzycki, Michael A. PurdyAbstract:Background: The ongoing hepatitis A outbreak in the United States has concerned public health authorities since March 2017. The outbreak has already spread throughout 30 states and includes primarily homeless individuals and persons who use Drugs, including persons who inject Drugs (PWIDs). Contaminated Drug injection Paraphernalia and sharing of these items are suspected to be one of multiple causes of hepatitis A virus (HAV) transmission in those populations. Methods: We used a standard plaque assay to investigate HAV infectivity. Liquid suspensions of HAV were tested to examine the effects of time and temperature on viral infectivity. We also examined HAV survival on commonly used Drug Paraphernalia, such as needles, syringes, cookers, tourniquets, and cotton balls/filters frequently shared among PWIDs. We investigated the effect of low pH on HAV survival using citric acid, which is frequently used by PWIDs during dose preparation. We also compared the plaque assay results with those concurrently obtained by RT-PCR to establish whether viral HAV RNA levels could be used as surrogates for plaque assay results. Results: We found that HAV suspended in PBS at room temperature was able to infect FRhk4 cells for >17 weeks. HAV remained viable in syringes and needles (ie, semidry conditions) for up to 10 weeks depending on the size of the needles and the syringe dead volume. HAV survival in dry conditions on cooker, tourniquet, and cotton balls/filter surfaces did not exceed 4 weeks. HAV retained its infectivity for >10 weeks at pH as low as 2. PCR results suggest that RNA is amplified from both infectious and noninfectious HAV. Conclusions: Our findings show that HAV can survive and remain infective in the PWID setting for 4–10 weeks depending on the type of Paraphernalia examined. These findings suggest that sharing Drug Paraphernalia by the homeless and PWIDs can potentially facilitate the transmission of HAV within these populations. Moreover, our results confirm that the plaque assay is currently the only reliable method to determine the infectivity of HAV in vitro.Funding: NoneDisclosures: None
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Hepatitis A virus survival on Drug Paraphernalia.
Journal of viral hepatitis, 2020Co-Authors: Magdalena Medrzycki, Saleem Kamili, Michael A. PurdyAbstract:The ongoing hepatitis A outbreaks in multiple states in the United States have concerned public health authorities since March 2017. The outbreaks have spread throughout 30 states and include primarily persons who use Drugs, including persons who inject Drugs (PWID) and persons experiencing homelessness. Contaminated Drug injection Paraphernalia and sharing of these items could potentially aid in transmission of hepatitis A virus (HAV) among these populations. We examined HAV survival on Drug Paraphernalia frequently shared among PWIDs. The effect of low pH on HAV survival using citric acid, which is frequently used by PWIDs during dose preparation, was investigated. We compared the plaque assay results with those concurrently obtained by qRT-PCR to establish whether HAV RNA levels could be used as surrogates for plaque assay results. HAV suspended in minimal essential media at room temperature infected FRhK4 cells for more than 17 weeks. HAV remained viable in syringes/needles for up to 10 weeks depending on the gauge of the needles and the syringe dead-volumes, and on cookers, tourniquets and cotton balls/filter surfaces for up to 4 weeks. HAV retained its infectivity for more than 10 weeks at pH as low as 2. In conclusion, our findings show that HAV survives and remains infective in or on injection Drug use equipment for 1 to 10 weeks depending on the type of Paraphernalia examined and environmental conditions. These findings suggest that contaminated Drug Paraphernalia can potentially facilitate the transmission of HAV within populations who share these items.
Holly Hagan - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and correlates of indirect sharing practices among young adult injection Drug users in five U.S. cities
Drug and Alcohol Dependence, 2007Co-Authors: Hanne Thiede, Holly Hagan, Jennifer V. Campbell, Steffanie A. Strathdee, Susan L. Bailey, Sharon M. Hudson, Farzana Kapadia, Richard S. GarfeinAbstract:Abstract Background Sharing of Drug Paraphernalia to prepare, measure and divide Drugs for injection remains an important residual risk factor for hepatitis C and other blood-borne infections among injection Drug users (IDUs) especially as sharing of syringes for injection decreases. Methods We analyzed data from five U.S. cities to determine the prevalence and independent correlates of non-syringe Paraphernalia-sharing (NSPS) and syringe-mediated Drug-splitting (SMDS) among 15–30-year-old IDUs who reported not injecting with others’ used syringes (receptive syringe-sharing, RSS). Results NSPS was reported by 54% of IDUs who did not practice RSS and was independently associated ( p Conclusions NSPS and SMDS were common among young adult IDUs. Increased efforts to prevent these risky practices should address social and environmental contexts of injection and incorporate knowledge and skills building, self-efficacy, and peer norms.
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The Tacoma Syringe Exchange
Journal of Addictive Diseases, 1991Co-Authors: Holly Hagan, Don C. Des Jarlais, David Purchase, Terry Reid, Samuel R. FriedmanAbstract:For over a year, the Tacoma Syringe Exchange has been operating in spite of existing Drug Paraphernalia laws. One hundred fifty-four subjects have been interviewed regarding Drug injection practices for the month prior to first use of the exchange and for the most recent month since using the exchange. Statistically significant reductions in mean frequency of obtaining used syringes, and in mean rate of passing on used syringes, have been reported. Mean number of times bleach was used to disinfect contaminated syringes has risen. The exchange continues to attract mainly men, median age 35, with a long history of injection. No differences have been observed in mean number of injections per month. In order to increase utilization, new sites are planned, but expansion has been hampered by a series of legal problems. Since the exchange draws many difficult to reach individuals, it is an important location for STD screening and Drug treatment recruitment. Documentation of participation patterns and barriers to...
