High dead-space syringe use among people who inject drugs in Tijuana, Mexico

Rafful, Claudia; Zule, William; González‐Zúñiga, Patricia; Werb, Dan; Medina‐Mora, María Elena; Magis-Rodriguez, Carlos; Strathdee, Steffanie A.

doi:10.3109/00952990.2015.1011742

Cited by 12 publications

(5 citation statements)

References 29 publications

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“…We note that the cost of an average dose of heroin is approximately $1.30 [ 34 ]. However, nearly 75% PWID in Tijuana inject more than once per day [ 35 ], suggesting that their daily heroin cost may be similar to their OST cost.…”

Section: Discussionmentioning

confidence: 99%

Cost of provision of opioid substitution therapy provision in Tijuana, Mexico

et al. 2018

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BackgroundMexico recently enacted drug policy reform to decriminalize possession of small amounts of illicit drugs and mandated that police refer identified substance users to drug treatment. However, the economic implications of drug treatment expansion are uncertain. We estimated the costs of opioid substitution therapy (OST) provision in Tijuana, Mexico, where opioid use and HIV are major public health concerns.MethodsWe adopted an economic health care provider perspective and applied an ingredients-based micro-costing approach to quantify the average monthly cost of OST (methadone maintenance) provision at two providers (one private and one public) in Tijuana, Mexico. Costs were divided by type of input (capital, recurrent personnel and non-personnel). We defined “delivery cost” as all costs except for the methadone and compared total cost by type of methadone (powdered form or capsule). Cost data were obtained from interviews with senior staff and review of expenditure reports. Service provision data were obtained from activity logs and senior staff interviews. Outcomes were cost per OST contact and cost per person month of OST. We additionally collected information on patient charges for OST provision from published rates.ResultsThe total cost per OST contact at the private and public sites was $3.12 and $5.90, respectively, corresponding to $95 and $179 per person month of OST. The costs of methadone delivery per OST contact were similar at both sites ($2.78 private and $3.46 public). However, cost of the methadone itself varied substantially ($0.34 per 80 mg dose [powder] at the private site and $2.44 per dose [capsule] at the public site). Patients were charged $1.93–$2.66 per methadone dose.ConclusionsThe cost of OST provision in Mexico is consistent with other upper-middle income settings. However, evidenced-based (OST) drug treatment facilities in Mexico are still unaffordable to most people who inject drugs.

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Section: Discussionmentioning

confidence: 99%

Cost of provision of opioid substitution therapy provision in Tijuana, Mexico

et al. 2018

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“…Rather, a likely factor contributing to HDSS in pharmacies is lack of awareness of syringe dead space among key stakeholders. Studies that have evaluated syringe usage patterns estimate that 40%-42% of PWID have ever used a HDSS and did so due to availability and ease of access (Rafful et al, 2015;Zule & Bobashev, 2009). PWID who engage in syringe sharing practices may not be aware of the problems of HDSS to request LDSS alternatives in the pharmacy.…”

Section: Discussionmentioning

confidence: 99%

Dead space in over-the-counter syringes: The implications for HIV and HCV transmission

Oramasionwu

Bailey

Moore

et al. 2015

International Journal of Drug Policy

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“…Worldwide, law enforcement has negatively impacted PWID willingness to purchase and carry sterile syringes, avoidance of sharing syringes and shooting galleries, and utilization of syringe exchange programs [ 21 – 35 ]. Police confiscation of both used and unused syringes negatively influences the way PWID consume drugs [ 4 , 8 , 10 , 13 – 17 , 23 , 36 – 48 ]. In addition to the negative health outcomes of incarceration in terms of infectious disease transmission, overdose, and structural vulnerability risk [ 49 , 50 ], arrests for syringe possession constitute a human rights and global health concern that may cause immediate and downstream harm to PWID.…”

Section: Introductionmentioning

confidence: 99%

Factors associated with extrajudicial arrest for syringe possession: results of a department-wide survey of municipal police in Tijuana, Mexico

Morales

Rafful

Gaines

et al. 2018

BMC Int Health Hum Rights

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BackgroundMexican law permits syringe purchase and possession without prescription. Nonetheless, people who inject drugs (PWID) frequently report arrest for syringe possession. Extrajudicial arrests not only violate human rights, but also significantly increase the risk of blood-borne infection transmission and other health harms among PWID and police personnel. To better understand how police practices contribute to the PWID risk environment, prior research has primarily examined drug user perspectives and experiences. This study focuses on municipal police officers (MPOs) in Tijuana, Mexico to identify factors associated with self-reported arrests for syringe possession.MethodsParticipants were active police officers aged ≥18 years, who completed a self-administered questionnaire on knowledge, attitudes and behaviors related to occupational safety, drug laws, and harm reduction strategies. Univariable and multivariable logistic regression was used to identify correlates of recent syringe possession arrest.ResultsAmong 1044 MPOs, nearly half (47.9%) reported always/sometimes making arrests for syringe possession (previous 6mo). Factors independently associated with more frequent arrest included being male (Adjusted Odds Ratio [AOR] = 1.62; 95% Confidence Interval [95% CI] =1.04–2.52; working in a district along Tijuana River Canal (where PWID congregate) (AOR = 2.85; 95%CI = 2.16–3.77); having recently experienced a physical altercation with PWID (AOR = 2.83; 95% CI = 2.15–3.74); and having recently referred PWID to social and health services (AOR = 1.97; 95% CI = 1.48–2.61). Conversely, odds were significantly lower among officers reporting knowing that syringe possession is legal (AOR = 0.61; 95% CI = 0.46–0.82).ConclusionsPolice and related criminal justice stakeholders (e.g., municipal judges, prosecutors) play a key role in shaping PWID risk environment. Findings highlight the urgent need for structural interventions to reduce extra-judicial syringe possession arrests. Police training, increasing gender and other forms of diversity, and policy reforms at various governmental and institutional levels are necessary to reduce police occupational risks, improve knowledge of drug laws, and facilitate harm reduction strategies that promote human rights and community health.

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High dead-space syringe use among people who inject drugs in Tijuana, Mexico

Cited by 12 publications

References 29 publications

Cost of provision of opioid substitution therapy provision in Tijuana, Mexico

Cost of provision of opioid substitution therapy provision in Tijuana, Mexico

Dead space in over-the-counter syringes: The implications for HIV and HCV transmission

Factors associated with extrajudicial arrest for syringe possession: results of a department-wide survey of municipal police in Tijuana, Mexico

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