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PubMed2002

New syringe acquisition and multi-person use of syringes among illegal drug users.

OBJECTIVES: This study reports on characteristics associated with "new" syringes by IDUs in Houston, Texas, where acquisition to sterile syringes is largely limited to pharmacy purchase. METHODS: Data were collected from street-recruited injection drug users in Houston, Texas. "New" syringe use was defined as always injecting with syringes that were obtained brand new from a pharmacy and that were always wrapped in plastic when they were purchased. Logistic regression was used to assess whether "new" syringe use affected the odds of injecting after other persons, and to assess individual characteristics associated with exclusive use of "new" syringes. RESULTS: Exclusive "new" needle use significantly decreased the odds that a respondent would report injecting after someone other than a sex partner, while methamphetamine consumption significantly increased the odds. None of the African-American injectors in the sample reported "new" syringe use. Social desirability and heroin consumption increased the odds that a respondent would report "new" syringe use. CONCLUSIONS: Results are consistent with previous studies showing that acquisition of new syringes reliably decreases multi-person use of syringes and may thus slow the spread of HIV.

Adult↗

PubMed2006

Factors associated with buying and selling syringes among injection drug users in a setting of one of North America's largest syringe exchange programs.

We performed analyses of syringe buying and syringe selling among Vancouver injection drug users, recruited from May 1996 and followed up between November 2002 and August 2003, in the context of one of North America's largest syringe exchange programs (SEPs). An interviewer-administered questionnaire, approximately 45 minutes in duration, was used to collect information regarding risk factors for HIV infection and sources of sterile syringes. Seventy participants (15%) reported syringe selling and 122 (26%) reported syringe buying. Syringe sellers were more likely to be female, reside in unstable housing, need help injecting, and have visited the SEP at least once weekly. Syringe buyers were more likely to need help injecting, have difficulty finding new syringes, have binged on drugs, and have visited the SEP at least once weekly. Syringe buying most frequently occurred when the SEP was closed.

Acquired Immunodeficiency Syndrome↗

PubMed2000

The effects of syringe plunger design on drug delivery during vertical displacement of syringe pumps.

Fluid delivery from four types of commercially available 50-ml syringes was measured using an electronic balance at an infusion rate of 1 ml.h(-1). Retrograde aspiration volume and zero-drug delivery time were recorded after lowering the syringe pump by 50 cm. Syringe compliance was calculated from the volume of bolus released after occlusion at 100 mmHg. Zero-drug delivery times differed significantly between syringes, ranging from [mean (SD)] 3.26 (0.40) min to 6.38 (0.56) min (F = 55.5, d.f. = 3/20, p < 0.0001). Syringe compliance correlated well with aspiration volume (Pearson r(2) = 0.92, p < 0.001) and zero-drug delivery time (r(2) = 0.90, p < 0.001). Syringe design affected the internal syringe compliance. All syringes were associated with potentially relevant zero-drug delivery times after moderate vertical displacement. To minimise this risk, vertical displacement of syringe pumps delivering highly vasoactive drugs should be avoided.

Compliance↗

PubMed2005

Receptive syringe sharing among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program.

BACKGROUND: Effective on January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), which allows syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to persons 18 years of age or older and permits the possession of those syringes for the purposes of injecting drugs. OBJECTIVE: To assess changes in receptive syringe sharing since the inception of the ESAP. METHODS: Sociodemographic characteristics and syringe use data regarding the last injection episode were combined from 3 projects (n = 1181) recruiting injection drug users in ongoing studies in Harlem and the Bronx in New York City from January 2001 through June 2003. These data were analyzed as serial cross sections by calendar quarter. RESULTS: Receptive sharing decreased significantly over time, from 13.4% in the first quarter to 3.6% in the last quarter. Obtaining the last injection syringe from an ESAP source (mostly pharmacies) increased significantly over time, from 7.5% in the first quarter to 25.0% in the last quarter. In multiple logistic regression analysis, variables that were significantly associated with less receptive sharing were syringe exchange and ESAP syringe source as well as time since ESAP inception. Female gender and white race/ethnicity were significantly associated with greater receptive sharing. CONCLUSIONS: The increase in the use of pharmacies and other ESAP syringe sources in this sample has been accompanied by a decline in receptive sharing.

Adult↗

PubMed1982

Effects of syringe material and needle size on the minimum plunger-displacement pressure of arterial blood gas syringes.

We determined the minimum systolic pressures required for blood to enter and begin to displace the plungers of four brands of 3-ml and 5-ml plastic and glass arterial blood gas syringes by combining samples of each syringe size with three sizes of short-beveled needles--25 gauge, 5/8"; 22-gauge, 1"; and 20-gauge, 1 1/2". We measured pressures by use of an arterial-vessel model that incorporated whole human blood and simulated the conditions of a percutaneous arterial puncture. We concluded that all the arterial blood gas syringes that we studied would self-fill in most clinical situations when they were combined with 20- or 22-gauge needles, but that 22-gauge needles with glass syringes were preferable for persons whose systolic pressures were less than 70 mm Hg, for persons in shock, and for persons undergoing CPR. Only glass 3-ml syringes should be used with 25-gauge needles, as two brands of plastic 3-ml syringes with 25-gauge needles required systolic pressures greater than 158 mm Hg and all brands of plastic and glass 5-ml syringes with 25-gauge needles required systolic pressures greater than 247 mm Hg. Because we found no clinical or statistical differences between 20- and 22-gauge needles, we do not recommend use of the larger 20-gauge needle. The syringe-needle combinations that we do recommend should negate the need for, and the potential trauma of, manual aspiration of the syringe plunger.

Blood Gas Analysis↗

PubMed2006

Syringe disposal among injection drug users in Harlem and the Bronx during the New York State Expanded Syringe Access Demonstration Program.

Effective January 1, 2001, New York State enacted the Expanded Syringe Access Demonstration Program (ESAP), allowing syringes to be sold in pharmacies without a prescription or dispensed through doctors, hospitals, and clinics to adults. A concern in the assessment of ESAP is its effects on syringe disposal practices. Syringe use data regarding the last injection episode were combined from three projects (N = 1,030) recruiting injection drug users. Disposal of syringes by methods known to be safe decreased significantly over time after the implementation of ESAP. Syringes obtained either from syringe exchange programs or ESAP sources were more likely to be disposed of safely than syringes obtained from other sources. Efforts to enlist pharmacists and others involved in ESAP implementation to encourage safe disposal are needed. More detailed information on disposal practices is needed to capture the continuum from least to most safe practices and variation within individuals.

Adolescent↗

PubMedDate not supplied

Impact of increased syringe access: preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York.

OBJECTIVE: To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. DESIGN: Pre-post comparison. SETTING: In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. MAIN OUTCOME MEASURES: Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. RESULTS: Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% (P < .001, and ever pharmacy use increased: 4.9% to 12.5% (P < .001), respectively. Compared with pre-ESAP IDUs, post-ESAP IDUs tended to be younger and more often black. Harlem pharmacy participation in ESAP increased considerably from March 1, 2001, to March 1, 2002, 49% to 79%, respectively. Among three Harlem pharmacies, there was a modest increase in NPSS; pharmacists reported no problems, and no discarded needles and syringes were observed in pharmacy areas. In the three pharmacies, the proportion of syringe sales that were NPSS was 46% (110 to 240 NPSS/month), 3% (25 to 90 NPSS/month), and 0%. The mean ratios of needles/syringes to background trash have not increased in Harlem since ESAP began. CONCLUSION: To date, no evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.

Humans↗

PubMedDate not supplied

Pharmacy syringe sale practices during the first year of expanded syringe availability in New York City (2001-2002).

OBJECTIVE: [corrected] To assess the role that customer characteristics, including race, age, and gender and pharmacy characteristics, including type and location, play on actual syringe-selling practice by pharmacies registered to sell syringes under the New York State Expanded Syringe Access Demonstration Program (ESAP). DESIGN: 89 syringe-purchasing visits were made in randomly selected ESAP-registered pharmacies, stratified by chain and independent status. SETTING: Visits were conducted in 14 New York City neighborhoods. Three neighborhoods (two with high need for human immunodeficiency virus [HIV] prevention services and one with low need) were selected in each of New York City's five boroughs (except Staten Island, where only two neighborhoods were visited, as only one exists with high need for HIV prevention services). PARTICIPANTS: Visits were conducted by syringe-purchasing testers with different demographic characteristics, including age (< or = 25 and > 25), race/ethnicity (white, black, Latino), and gender (men, women). RESULTS: Testers were able to purchase syringes in 69% of visits. Tester race, age, and gender did not significantly affect sales of syringe-selling practices. Location of pharmacy was statistically significant, with only 33% of the registered pharmacies selling syringes in the Bronx, but 67% to 89% selling in other four boroughs. CONCLUSIONS: ESAP has been widely implemented among registered pharmacies in four of New York City's five boroughs. The program's effectiveness could be enhanced through pharmacy-based efforts focused broadly on the ESAP goal of preventing the transmission of HIV and other blood-borne infections among injection drug users.

HIV Infections↗

PubMed1999

Use of SoloShot autodestruct syringes compared with disposable syringes, in a national immunization campaign in Indonesia.

Autodestruct syringes can reduce the improper reuse of syringes, which present a significant risk in the transmission of bloodborne pathogens in developing countries, especially during immunization campaigns owing to the high number of injections given per session. SoloShot is an autodestruct syringe, distributed by UNICEF, which has been shown to be safer and easier to use than standard syringes. This study analyses the accuracy and dose-efficiency of SoloShot, compared with disposable syringes, during a national tetanus toxoid immunization campaign on the Indonesian island of Lombok. Observation and dose measurements revealed that SoloShot syringes delivered more precise and consistent doses and 15% more doses per vial than disposable syringes. Vaccine savings may partially be offset by the higher price of SoloShot. Vaccinators preferred SoloShot, describing it as easier to use, faster, and more accurate than the disposable syringe. The study indicates that SoloShot is highly appropriate for use in immunization campaigns by reducing vaccine wastage and improving injection safety.

Adult↗

PubMed1992

Effect of two different syringes on syringe driver function.

A laboratory investigation into the effect of two different syringes on the performance of a syringe driver was undertaken in order to assess accuracy of delivery, occlusion-alarm delay time and the effect of incorrectly coding the device for the syringe in use. Results indicated that accuracy of delivery was of the order of -1%/h for both syringe types at an infusion rate of 5 ml/h. Clinically and statistically significant differences in the occlusion-to-alarm time were found between syringes and between infusion rates. At 99.9 ml/h lag time was about 30 seconds for both syringes, whereas at 5 ml/h this was 667 seconds for one syringe and 903 seconds for the other. Incorrect coding of the driver for the syringe in use, resulted in a significant change in the accuracy of delivery at an infusion rate of 5 ml/h. Similarly, incorrect coding resulted in changes in the occlusion-alarm time. These results carry significant pharmacological implications for the clinical situation.

Humans↗

PubMed2000

[The effect of air within the infusion syringe on drug delivery of syringe pump infusion systems] .

Application of highly concentrated short-acting vasoactive drugs in the critically ill patient requires precisely working syringe pump systems for continuous intravenous drug delivery. We performed a bench study to investigate the consequences of small amounts of air entrapped within a 50-ml infusion syringe. In particular we studied the effect of entrapped air on drug delivery after moderate vertical displacement of the pump by 50 cm (e.g. in preparation for transport) and the effect on the time required to trigger the pressure alarm after occlusion of the infusion line. At a flow rate of 1 ml/h, lowering the syringe pump prolonged the zero-drug delivery time from (mean +/- SD) 4.1 +/- 0.8 min (without air) to 6.2 +/- 0.9 (with 1 ml air) and to 13.1 +/- 0.9 min (with 2 ml of air, p < 0.001 for all comparisons). Entrapping of 2 ml of air within the syringe resulted in a 2.6-fold prolongation of the occlusion alarm time after accidental occlusion of the infusion line and a 3-fold increase of the resulting infusion bolus after occlusion. Enclosed air within infusion syringes considerably affects the syringe compliance. It increases the susceptibility of constant drug delivery to vertical displacement of syringe pumps and impairs the occlusion alarm function. Therefore, any air in syringe of infusion pump systems should be carefully removed. To avoid infusion boluses of short-acting vasoactive drugs after accidental occlusions, the occluded infusion line should be released to ambient pressure first.

Air↗

PubMed2006

Safe syringe disposal is related to safe syringe access among HIV-positive injection drug users.

We evaluated the effect of syringe acquisition on syringe disposal among HIV-positive injection drug users (IDUs) in Baltimore, New York City, and San Francisco (N = 680; mean age 42 years, 62% male, 59% African-American, 21% Hispanic, 12% White). Independent predictors of safe disposal were acquiring syringes through a safe source and ever visiting a syringe exchange program. Weaker predictors included living in San Francisco, living in the area longer, less frequent binge drinking, injecting with an HIV+ partner, peer norms supporting safe injection, and self-empowerment. Independent predictors of safe "handling"-both acquiring and disposing of syringes safely-also included being from New York and being older. HIV-positive IDUs who obtain syringes from a safe source are more likely to safely dispose; peer norms contribute to both acquisition and disposal. Interventions to improve disposal should include expanding sites of safe syringe acquisition while enhancing disposal messages, alternatives, and convenience.

Adult↗

PubMed1986

Microbial contamination potential of solutions in prefilled disposable syringes used with a syringe pump.

The sterility of trypticase soy broth (TSB) that was frozen and thawed in disposable plastic syringes and infused via syringe pump was studied to determine whether ambient air or personnel-transferred contaminants compromised the sterility of the solution. Samples of TSB (10, 20, 30 mL) were prepared aseptically in syringes of three different brands--150 samples for each volume (50 for each manufacturer). The syringes were placed in zip-lock bags, stored for 24 hours at -15 to -20 degrees C, and thawed for three hours. Both positive and negative controls were used. For the test samples, infusion sets were connected to the syringes under aseptic conditions, and the solution was infused via syringe pump in ambient air into polyvinyl chloride minibags before incubation. The remaining samples were prepared in the same manner as the test solutions except that they were intentionally challenged with Bacillus subtilis introduced distal to the plunger. All samples were inspected visually for turbidity after a 14-day incubation period. There was no growth in any of the test infusion samples or in samples that were intentionally contaminated. The negative controls showed no growth; all of the positive controls showed growth. The sterility of solutions frozen in disposable plastic syringes does not appear to be compromised by touch contamination of the plunger shaft or by airborne microorganisms settling on the infusion system.

Bacteria↗

PubMed2000

New York State pharmacists' attitudes toward needle and syringe sales to injection drug users before implementation of syringe deregulation.

In May 2000, New York State passed legislation permitting the sale, purchase, and possession of up to 10 needles and syringes without a prescription. The law is intended to reduce the transmission of human immunodeficiency virus (HIV) and hepatitis among injection drug users (IDUs), their sexual partners, and their children. To obtain baseline information about the attitudes and likely practices of New York State pharmacists, we distributed a self-administered questionnaire to attendees of the state pharmacy association meeting in June 2000. Of 48 usable responses, 19% were from New York City and the rest from New York State. Of the 48, 42% were unaware of the new law before the day of the survey, and 60% were somewhat or very willing to sell needles and syringes to an IDU. Of those who were not willing to sell to an IDU, 82% cited familiarity of the customer as a very important consideration in their decision making. Those who were not willing to sell to an IDU were more concerned about the detrimental impact of syringe sales on the community, were less likely to be aware of the new law, and were more likely to be concerned about legal liability for syringe sales. Over 80% of all pharmacists believed that syringe sales to IDUs are an important preventive health measure. The majority also favored learning more about the law. Compared to other state surveys of pharmacists, these preliminary data show a similar level of interest in becoming involved with syringe availability programs.

Attitude of Health Personnel↗

PubMed2006

Improving access to sterile syringes and safe syringe disposal for injection drug users in methadone maintenance treatment.

We evaluated a novel intervention designed to improve access to sterile syringes and safe syringe disposal for injection drug users (IDUs) newly enrolled in methadone maintenance, through interviews with two sequential cohorts of 100 recent entrants into a methadone program in the Bronx, NY. A substantial number of participants had injected in the previous 6 months, and most continued injecting during the early weeks of treatment. The intervention was associated with significant behavior changes among IDUs, including increased use of pharmacies as a primary source of syringes (11% vs. 37%, p < .05) and decreases in both purchasing of syringes on the street (51% vs. 27%, p < .05) and needle sharing (40% vs. 7%, p < .01). The intervention had no impact on the prevalence of injection or on syringe disposal practices. Our findings suggest that drug treatment programs can serve an important role in reducing injection-related risk behavior by facilitating access to sterile syringes.

Adult↗

PubMedDate not supplied

[Community collection of syringes by parenteral drug users complementary to syringe exchange programs].

OBJECTIVES: To contribute to harm reduction in injecting drug users (IDUs) by the implementation of a programme to withdraw abandoned syringes from public places, as well as to collaborate on the social reinsertion of IDUs. METHODS: Descriptive study of the Syringe Withdrawal Community (RECOJE in Spanish), carried out from 1997 to 1999 by IDUs, the We Are Helpful Association (ASUT in Spanish) and the Social and Health Prevention and Attention Service (SAPS in Spanish) of the Red Cross, in Ciutat Vella (Barcelona, Spain). RESULTS: 4,332 syringes were withdrawn, 849 in 1997, 1,324 in 1998 and 2,159 in 1999. The mean number of syringes withdrawn each time was 57 33. 45 different IDUs worked in RECOJE. 74.2% of the abandoned syringes were found in parks, gardens, car parks and open spaces. CONCLUSIONS: RECOJE can be a valid programme for harm reduction complementary to the exchange syringe programmes. It could improve the self-esteem, external image and organization of IDUs, contributing to their social reinsertion.

Adult↗

PubMed2001

Downward movement of syringe pumps reduces syringe output.

We studied how lowering a syringe pump and changing the outflow pressure could affect syringe pump output. We experimentally reduced the height of three different syringe pump systems by 80 cm (adult setting) or 130 cm (neonatal setting), as can happen clinically, using five flow rates. We measured the time of backward flow, no flow and the total time without flow. An exponential negative correlation was present between infusion rate and time without flow (r2=0.809 to 0.972, P<0.01). Minimum flow rates of 4.4 and 2.6 ml h(-1) respectively were calculated to give 60 and 120 s without infusion. The compliance of the different syringe pumps and their infusion systems was linearly correlated with the effective time without infusion (r2=0.863, P<0.05). We conclude that the height of the syringe pumps should not be changed during transportation. If vertical movement of the syringe pump is necessary, the drugs should be diluted so that the flow rate is at least 5 ml h(-1).

Adult↗

PubMed2003

[Cost-benefit analysis on the replacement program of ordinary syringes by auto-disposal syringes in China].

OBJECTIVE: To explore the feasibility of replacement of ordinary syringes by auto-disposal syringes (AD) in China. METHODS: Sampling survey was conducted in Hebei province to collect data on the direct medical spending of hepatitis B and their Disability Adjusted Life Year (DALY) losses. The financial burden on hepatitis B was calculated based on the result of field survey as well as through data-base of the Second National Health Services Survey of MOH in 1998. The cost-benefit analysis was employed, in which the saving of the financial burden on hepatitis B patients attributing to unsafe injections was taken as the benefit of intervention and the increased expenditures of AD syringes as the costs. RESULTS: The total financial disease burden of Hepatitis B in China in 2001 was between RMB 16.19 and 20.17 billion Yuan and the financial disease burden per patient was between RMB 1755.38 and 1409.64 Yuan. Study on the cost-benefit analysis in the replacement intervention program showed high financial feasibility. The Benefit-Cost Ratio (BCR) of the measure was between 32.46 and 97.39, which was bigger in rural areas than that in cities. The direct BCR was less than one when the price gap between ordinary syringe and AD exceeded RMB 0.24 Yuan. CONCLUSION: The intervention of safe injection practice through universal usage of AD to replace ordinary syringe seemed to be applicable due to its high potential economic benefits.

China↗