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PubMed1998

[Characteristics of attenders of low threshold syringe-exchange centers providing sterile syringes in Switzerland].

BACKGROUND: The objectives of the present study were to evaluate Aids prevention in drug users attending low threshold centres providing sterile injection equipment in Switzerland, to identify the characteristics of these users, and to monitor the progress of indicators of drug-related harm. METHODS: This paper presents results from a cross-sectional survey carried out in 1994. RESULTS: The mean age of attenders was 28 years, and women represented 27% of the sample. 75% of attenders used a combination of hard drugs (heroin and cocaine). Mean duration of heroin consumption was 8 years, and of cocaine 7 years; 76% of attenders had a fixed abode, but only 34% had stable employment; 45% were being treated with methadone; 9% had shared their injection material in the last 6 months; 24% always used condoms in the case of a stable relationship, and 71% in casual relationships. In a cluster analysis constructed on the basis of multiple correspondence analysis, two distinct profiles of users emerge: highly marginalised users with a high level of consumption (21%); irregular users, better integrated socially, of which the majority are under methadone treatment (79%). CONCLUSION: Theses centres play a major role in Aids prevention. Nevertheless, efforts to improve the hygiene conditions of drug injection in Switzerland should be pursued and extended. At the same time, prevention of HIV sexual transmissions should be reinforced.

Acquired Immunodeficiency Syndrome↗
PubMed2004

Sterile syringe access conditions and variations in HIV risk among drug injectors in three cities.

AIM: Better sterile syringe access should be associated with a lower likelihood of syringe re-use and receptive syringe sharing, although few empirical studies have examined gradients in syringe access using both individual and ecological data. In this study, we compare syringe re-use and receptive syringe sharing among injection drug users (IDUs) with syringe exchange program (SEP) and legal over-the-counter pharmacy access with limits on syringes that can be purchased, exchanged or possessed to IDUs with no pharmacy sales but unlimited syringe access through SEPs. We address three questions: (1) Does residing in an area with no legal syringe possession increase the likelihood of police contact related to possessing drug paraphernalia? (2) Among direct SEP users, is use of more permissive SEPs associated with less likelihood of syringe re-use and receptive syringe sharing? (3) Among non-SEP users, is residing in an area with pharmacy access associated with lower likelihood of syringe re-use and receptive syringe sharing? DESIGN: Quantitative survey of IDUs recruited from SEPs, subject nomination and outreach methods. Multivariate analyses compared police contact, syringe re-use and receptive syringe sharing among IDUs recruited in three cities. FINDINGS: In multivariate analyses, we found that police contact was associated independently with residing in the area with no legal possession of syringes; among SEP users, those with access to SEPs without limits had lower syringe re-use but not lower syringe sharing; and that among non-SEP users, no significant differences in injection risk were observed among IDUs with and without pharmacy access to syringes. CONCLUSION: We found that greater legal access to syringes, if accompanied by limits on the number of syringes that can be exchanged, purchased and possessed, may not have the intended impacts on injection-related infectious disease risk among IDUs.

Adult↗
PubMed1998

Feasibility of one-time use of sterile syringes: a study of active injection drug users in seven United States metropolitan areas.

OBJECTIVES: To assess the feasibility of advice to injection drug users (IDUs) to use a sterile syringe for each injection, we examined sources of syringes, syringe use and reuse, and barriers to and facilitators of compliance with the one-time use of syringes by active IDUs in seven U.S. metropolitan areas. METHODS: Brief, interviewer-administered surveys were completed by 593 active IDUs, defined as injection reported within the past 90 days, in seven U.S. metropolitan areas characterized by various restrictions on syringe acquisition and possession. RESULTS: Most of the IDUs interviewed were male (69%) and African American (74%). Overall, only 23% obtained the most recently used syringe from a reliable source of sterile syringes (i.e., pharmacy or syringe exchange program [SEP]). The median number of injections per most recently used syringe was 3 (mean=5.2); 21% used the syringe only once. IDUs were more likely to have used a reliable source for obtaining their most recent syringe in cities with a SEP (odds ratio [OR]=5.3; 95% confidence interval [CI] 3.3-8.5) or without restrictive paraphernalia laws (OR=0.1; 95% CI 0.1-0.3). To facilitate one-time use of sterile syringes, IDUs recommended the provision of free syringes (50.3%), access to a SEP (38.1%), and access to pharmacy purchase of syringes (24.0%). CONCLUSIONS: Restrictions on syringe availability and the beliefs and practices of IDUs are barriers to the public health recommendation of one-time use of sterile syringes for IDUs who cannot stop injecting. Increased access to legal, inexpensive sterile syringes and education about the merits of one-time use are needed.

Black or African American↗
PubMed1998

Arrests and incarceration of injection drug users for syringe possession in Massachusetts: implications for HIV prevention.

Multiperson use of syringes is a major risk behavior responsible for the spread of HIV-1 among injection drug users (IDUs). In Massachusetts, two laws regulate syringes: one is a prescription law prohibiting possession or purchase of syringes without a prescription, and the other makes it illegal to possess drug paraphernalia, including syringes. In 1993, Massachusetts amended the prescription law to permit the establishment of syringe exchange programs in two cities. Enrolled participants are allowed to possess syringes anywhere in the state, and about 5% of the estimated 40,000 IDUs in Massachusetts are program participants. To understand how HIV prevention efforts with active IDUs may be constrained by the enforcement of laws criminalizing possession of syringes after the amendment in the law, we reviewed data from multiple sources to assess the number of arrests for syringe possession in 10 large cities in Massachusetts to evaluate incarceration rates and lengths of sentences for those convicted of syringe possession and to estimate costs of incarceration for those convicted of syringe possession. At least 824 persons were arrested for syringe possession in 1995. In examining the data on convictions, we found that 417 persons were convicted in 1994 of syringe possession in the absence of other serious charges, and of these, 41.0% were sentenced to incarceration. The average sentence imposed was 5 months (range, 3 days-2 years). Assuming that those convicted serve about two thirds of their sentences, the cost of incarceration was estimated at $1,140,183 excluding costs for arrest, pretrial detention, prosecution, or other costs of enforcement. Costs for incarcerating persons convicted of both syringe and drug possession were not included; the total cost of incarceration of persons convicted of possession of a syringe, with or without other major charges, is probably considerably higher. Had these funds been allocated to pay for drug treatment, 1629 admissions to drug detoxification programs could have been purchased. Retaining drug paraphernalia and syringe prescription laws in Massachusetts may contribute to HIV transmission. These findings support the recommendation of the American Medical Association to modify drug paraphernalia laws so that IDUs can purchase and possess syringes without a prescription.

Boston↗
PubMed2006

Multiperson use of syringes among injection drug users in a needle exchange program: a gene-based molecular epidemiologic analysis.

Syringe-sharing behaviors among injection drug users (IDUs) are typically based on self-reports and subject to socially desirable responding. We used 3 short tandem repeat (STR) genetic biomarkers to detect sharing in 2,512 syringes exchanged by 315 IDUs in the Baltimore needle exchange program (NEP; 738 person-visits). Demographic characteristics as well as direct and indirect needle-sharing behaviors corresponding to the closest AIDS Link to Intravenous Experience (ALIVE) study visits were examined for association with multiperson use (MPU) of syringes. Overall, 56% of the syringes exchanged at the Baltimore NEP had evidence of MPU. Less MPU of syringes (48% vs. 71%; P < 0.0001) was seen with more rapid syringe turnaround (<3 days). IDUs always exchanging their own syringes ("primary" syringes) were less likely to return syringes with evidence of MPU (52%) than those who exchanged syringes for others ("secondary" syringes; 64%; P = 0.0001) and those exchanging primary and secondary syringes (58%; P = 0.004). In a multivariate analysis restricted to primary exchangers, MPU of syringes was associated with sharing cotton (adjusted odds ratio [AOR] = 2.06, 95% confidence interval [CI]: 1.30 to 3.28), lending syringes (AOR = 1.70, 95% CI: 1.24 to 2.34), and injecting less than daily (AOR = 0.64, 95% CI: 0.43 to 0.95). These findings support additional public health interventions such as expanded syringe access to prevent HIV and other blood-borne infections. Testing of STRs represents a promising approach to examining and accessing complex behavioral data, including syringe sharing.

Adult↗
PubMed1999

[2000-year history of the ear syringe and its relationship to the enema. Images from the history of otorhinolaryngology, represented by instruments from the collection of the Ingolstadt Medical History Museum].

SYRINGES WITH A PISTON AND THEIR USE AS "CLYSTER ORICULARIUS" IN THE ANCIENT ROME: Syringes with a piston were already known in ancient times and have been mentioned as a device for spraying rose water (Philon of Byzantium, about 230 BC), and for fighting fires (Heron of Alexandria about 110 AD). Celsus mentions it several times in his grand opus "De Medicina" (1st century AD) in the treatment of purulent discharge from the ear and for removing foreign bodies from the external ear canal. He always calls it "clyster oricularius", i.e. ear syringe, even when he describes its use in applications other than otological, such as in urology. Later the ear syringe fell from favor for a very long time and was reinvented only at the beginning of the 19th century. IRRIGATION OF THE BOWELS, FROM THE BAG SYRINGE TO THE PISTON SYRINGE: Irrigations of the bowels, clysters, were performed from ancient times to the 18th century with a baglike syringe using the bladder of animals as a pouch. Syringes with a piston were used by barbers and surgeons only for cleansing wounds or irrigating natural cavities of the body. Irrigation of the external ear canal had completely fallen from favor. In France in the 18th century large syringes with a piston made of tin oder brass came into use for enemas and replaced the old baglike devices. THE REINVENTION OF THE EAR SYRINGE AFTER THE PROTOTYPE OF THE ENEMA SYRINGE: Itard, an otologist in France in 1821, was the first to describe irrigating the ear with a syringe to remove hard wax. He recommended using an enema syringe ("seringue à lavement") for the procedure. Soon after his publication special ear syringes of appropriate size were developed and described by Beck in Freiburg, Germany, in 1827; by Fabrizi in Modena, Italy, 1839; and Schmalz in Dresden, Germany, 1846, who also introduced the kidney-shaped bowel for catching the water. Apart from that, small baglike syringes made of rubber were devised especially for use by the patient himself (Kramer, Berlin, 1860). This historical development is described in detail and illustrated by numerous figures.

Enema↗
PubMed1994

Syringe and needle exchange as HIV/AIDS prevention for injection drug users.

OBJECTIVE: To evaluate an all-volunteer syringe exchange program in San Francisco, Calif. DATA SOURCES: Syringe exchange program records and 11 semiannual surveys administered during a 5.5-year period, using standard questionnaires. Interviews (N = 5644) were conducted with injection drug users recruited in two 21-day drug detoxification clinics and three street settings. MAIN OUTCOME MEASURES: Use of the syringe exchange program and self-reported data regarding sources of syringes, frequency of injection, initiation into drug injection, and frequency of syringe sharing. RESULTS: In spring 1992, 45% reported "usually" obtaining injection equipment from the syringe exchange, and 61% reported using the program within the past year. During the period from December 1986 through June 1992, the median reported frequency of injection declined from 1.9 injections per day to 0.7 injection per day, the mean age increased from 36 to 42 years, and the percentage of new initiates into injection drug use decreased from 3% to 1%. In logistic regression analysis (of fall 1991 through spring 1992 interviews; n = 752), we found six independent factors associated with syringe sharing. Protective from syringe sharing were use of the syringe exchange program, having received human immunodeficiency virus (HIV) testing and counseling, condom use, older age, and African-American race. Injection of cocaine was a predictor for syringe sharing. The strength of association between use of the syringe exchange program and not sharing syringes was greatest in injection drug users younger than the median age of 40 years. CONCLUSIONS: The syringe exchange program was rapidly adopted by injection drug users. Health interventions associated with not sharing needles included use of the syringe exchange program and voluntary, confidential HIV testing and counseling. Our data did not support the hypothesis that a syringe exchange program would stimulate increased drug abuse in terms of frequency of injection or recruitment of new and/or younger users.

Adult↗
PubMed2002

An audit of the use of self-administered adrenaline syringes in patients with angio-oedema.

BACKGROUND: Self-administered adrenaline syringes may be prescribed for patients at risk of life-threatening episodes of angio-oedema or anaphylaxis. OBJECTIVES: To determine whether patients are able to use these syringes appropriately and adequately. METHODS: Twenty-nine consecutive patients who had been prescribed self-administered adrenaline syringes for severe angio-oedema were recruited. All completed a questionnaire (unsupervised), and were asked to demonstrate how to use a dummy syringe. RESULTS: Three of 29 (10%) patients had been prescribed syringes in the absence of severe angio-oedema or collapse. Seventeen of 29 (59%) patients had been prescribed two syringes, and 21 of 29 (72%) kept a syringe with them at all times. Twenty of 28 (71%) patients had had the use of a syringe demonstrated to them with the initial prescription, but two of 29 (7%) had never been shown how to use it. Only six of 26 (23%) patients had been told to telephone for an ambulance after using a syringe. Only seven of 29 (24%) patients would use a syringe for an episode of collapse, whereas eight of 28 (29%) would use one for an episode of lip swelling. Nine of 21 (43%) patients had not been warned about adverse effects, although 13 of 20 (65%) given adrenaline had had at least one adverse effect. Of the 25 patients asked to demonstrate their use of a syringe, only 14 (56%) were able to perform all steps correctly, and three (12%) were unable to perform any of the steps. Despite this, all 29 patients felt confident about giving themselves an injection, and most felt more secure having been prescribed syringes. CONCLUSIONS: As self-administered adrenaline syringes are prescribed for life-threatening events, it is vital that they are given to appropriate patients with adequate written instructions and proper demonstration at the time of the initial prescription. As a result of this study we have developed a more detailed patient information leaflet, and all patients are shown how to use a syringe for a second time when attending the clinic for follow-up.

Adolescent↗
PubMed2002

Unexpected high risk of contamination with staphylococci species attributable to standard preparation of syringes for continuous intravenous drug administration in a simulation model in intensive care units.

OBJECTIVE: To determine the risk of bacterial contamination of the infusate in a simulation model of syringes prepared for continuous intravenous drug administration by intensive care unit nurses. Widely accepted standard procedures in the intensive care unit were compared with syringes prepared by pharmaceutical technicians working under standard aseptic conditions according to national guidelines. DESIGN: Prospective study. SETTING: Intensive care units of four general teaching hospitals and two university hospitals. SUBJECTS: We examined 650 syringes prepared from 10-mL ampules and 100 syringes prepared from rubber-compound-capped 50-mL vials by intensive care unit nurses of six hospitals. Also, 100 syringes from 10-mL ampules and 100 syringes from rubber-compound-capped 50-mL vials were prepared by pharmaceutical technicians. INTERVENTIONS: Turbidity of syringes after culturing for 7 days at 37 degrees C was used as the criterion for possible bacterial contamination, which was proved with subsequent Gram staining. MEASUREMENTS AND MAIN RESULTS: A median contamination rate of 22% (range, 7% to 44%) was observed for the syringes prepared from 10-mL ampules by intensive care unit nurses, compared with only 1% for the syringes prepared from ampules by technicians (p <.001). In >75% of all contaminated syringes, Gram-positive cocci were identified. At least 12% of all prepared syringes proved to be contaminated with staphylococci species. The contamination rate of syringes prepared from vials was much lower: 2% in the intensive care unit and 0% at the department of clinical pharmacy. CONCLUSIONS: In the intensive care unit, standard procedures for preparing syringes for intravenous administration of drugs lack vigorous aseptic precautions, leading to a high contamination rate of the infusate. This risk is increased when ampules instead of 50 mL-vials are used to prepare the syringes.

Equipment Contamination↗
PubMed1998

An economic analysis of needle exchange and pharmacy-based programs to increase sterile syringe availability for injection drug users.

Our objectives were to estimate the cost per syringe distributed for five syringe distribution strategies (a needle exchange program [NEP], a pharmacy-based NEP, free pharmacy distribution of pharmacy kits, sale of such pharmacy kits to injection drug users [IDUs], and sale of syringes in pharmacies); to assess the total costs of these strategies; and to conduct an economic analysis of these strategies in preventing HIV infection in IDUs. We estimated the costs for NEPs by using data from previous research; costs for the four pharmacy-based strategies were resource-based. Using estimates of the number of syringes required to provide a sterile syringe for each IDU injection, we estimated the total costs of the strategies in three representative U.S. cities. The lifetime cost of treating a person for HIV infection, discounted into current value, was used to estimate the number of syringes that could be distributed for that amount by the five strategies and thus the number of IDUs who could be ensured a sterile syringe for each injection. We then conducted a threshold analysis for calculating the annual HIV seroincidence for the program to be cost-neutral. The cost per syringe distributed in U.S. dollars was $0.97 for the NEP, $0.37 for the pharmacy-based NEP, $0.64 for pharmacy kit distribution, $0.43 for pharmacy kit sale, and $0.15 for syringe sale. The total annual cost in U.S. dollars of providing 50% of the syringes needed for a single syringe for every injection ranged from $6 to $40 million for New York City, from $1 to $6 million for San Francisco, and from $30,000 to $200,000 for Dayton, Ohio. The annual HIV seroincidence for the program to be cost-neutral compared with the cost of medical treatment for HIV injections was 2.1% for the NEP, 0.8% for the pharmacy NEP, 1.4% for pharmacy kit distribution, 0.9% for pharmacy kit sale, and 0.3% for syringe sale. All five strategies could distribute syringes at relatively low unit costs; NEPs would be the most expensive and syringe sales would be the cheapest. At annual seroincidences exceeding 2.1%, all strategies are likely to be cost-saving to society.

Costs and Cost Analysis↗
PubMedDate not supplied

The legality of selling or giving syringes to injection drug users.

OBJECTIVES: Laws limiting access to sterile syringes impede the public health goal that injection drug users (IDUs) use a new, sterile syringe for every injection to reduce blood-borne disease transmission. We sought to determine the legality of selling or giving syringes to IDUs to prevent disease. DESIGN: We used standard legal research methods to identify and analyze laws and regulations influencing the distribution of syringes in the 50 states, the District of Columbia, Puerto Rico, and the Virgin Islands. RESULTS: A total of 51 jurisdictions had drug paraphernalia laws; 14 had syringe prescription laws or regulations; 11 required purchasers to show identification; 13 had legislation authorizing syringe exchange programs (SEPs). Since the beginning of the human immunodeficiency virus epidemic, 11 states have fully or partially deregulated syringe sales. Nonprescription retail syringe sales to IDUs for disease prevention purposes are clearly legal in 20 states, and have a reasonable claim to legality in 22 more. Sales to IDUs with a prescription are clearly illegal in only 3 jurisdictions. SEPs can operate legally in at least 21 states. CONCLUSION: Syringe access laws in most states may reasonably be interpreted to allow pharmacists to sell syringes to IDUs to prevent disease. In practice, however, unclear laws and pharmacist uncertainty as to their interpretation may constitute continuing barriers to syringe access for IDUs. A comprehensive public policy of ensuring syringe access for IDUs requires eliminating legal barriers to the sale, possession, and disposal of syringes, and educating pharmacists and law enforcement officials about the legality and public health importance of sterile syringe access.

Humans↗