Associations Between Injection Risk and Community Disadvantage Among Suburban Injection Drug Users in Southwestern Connecticut, USA

Abstract

Increases in drug abuse, injection, and opioid overdoses in suburban communities led us to study injectors residing in suburban communities in southwestern Connecticut, US. We sought to understand the influence of residence on risk and injection-associated diseases. Injectors were recruited by respondent-driven sampling and interviewed about sociodemographics, somatic and mental health, injection risk, and interactions with healthcare, harm reduction, substance abuse treatment, and criminal justice systems. HIV, hepatitis B and C (HBV and HCV) serological testing was also conducted. Our sample was consistent in geographic distribution and age to the general population and to the patterns of heroin-associated overdose deaths in the suburban towns. High rates of interaction with drug abuse treatment and criminal justice systems contrasted with scant use of harm reduction services. The only factors associated with both dependent variables—residence in less disadvantaged census tracts and more injection risk—were younger age and injecting in one’s own residence. This contrasts with the common association among urban injectors of injection-associated risk behaviors and residence in disadvantaged communities. Poor social support and moderate/severe depression were associated with risky injection practices (but not residence in specific classes of census tracts), suggesting that a region-wide dual diagnosis approach to the expansion of harm reduction services could be effective at reducing the negative consequences of injection drug use.

Harm reduction for young people who use prescription opioids extra-medically: Obstacles and opportunities

“…First, many EMPO users do not belong to larger networks of street-based drug users, and are thus poorly connected to harm reduction and HIV prevention programs in their communities (Bruneau, et al, 2012; Firestone & Fischer, 2008). Second, many harm reduction programs are located in urban centers, often far from neighborhoods in which many young EMPO users reside, socialize, and use drugs (Frank, et al, 2015; Heimer, Barbour, Palacios, Nichols, & Grau, 2014). Third, generational, class, and other socially constructed boundaries (separating types of drug use and routes of administration), in addition to widespread stigmatization of older disadvantaged heroin users, contributes to EMPO-using youths’ reluctance to access harm reduction services (Frank, et al, 2015).…”

Prevalence and experience of chronic pain in suburban drug injectors

“…In sum, most of what we have learned about the relationship between chronic pain and addiction has been among those who have already assumed a patient role. What little is known about non-clinical populations who have untreated pain and substance use disorders come from urban and rural populations (Davis and Johnson, 2008; Havens et al, 2009; Wunsch et al, 2008), but nothing about suburban people who inject drugs (PWID) who differ from their urban counterparts in that none is homeless or resides in neighborhoods that are deemed most disadvantaged, the vast majority is white, they are a decade younger on average than sample drawn from urban centers (Heimer et al, 2014). …”

“…The vast majority injected heroin, and one-third injected more than one substance in the thirty days prior to their entry into our study (Akselrod et al, 2014; Heimer et al, 2014). Unlike urban areas, individuals reported little contact with harm reduction services, but like their urban counterparts the majority had experience both in the criminal justice system and with substance abuse treatment programs.…”

Deportation and mental health among migrants who inject drugs along the US–Mexico border

“…This is a 10-item screening instrument that has demonstrated high reliability and validity for identifying current (past week) depressive symptomology related to major or clinical depression in adults, including Latino populations, Mexican/Latino migrants, and PWID (Grzywacz et al, 2010; Grzywacz, Hovey, Seligman, Arcury, & Quandt, 2006; Heimer, Barbour, Palacios, Nichols, & Grau, 2014; Lum & Vanderaa, 2010; Ulibarri et al, 2013). Notably, the Spanish version of this scale has been validated and utilized among diverse populations, including rural populations, deported migrants, and PWID (Bojorquez Chapela & Salgado de Snyder, 2009; Salgado-De Snyder & Maldonado, 2013; Ulibarri et al, 2013).…”