Public injecting and the need for ‘safer environment interventions’ in the reduction of drug‐related harm

Abstract

Public health interventions in the addictions field have in the past focused upon individual behavioural change at the cost of social interventions and environmental change. We wish to focus greater attention on reducing risks related to public injecting and encourage greater debate on 'safer environment interventions' in harm reduction.

Housing Instability among People Who Inject Drugs: Results from the Australian Needle and Syringe Program Survey

“…Our results are consistent with previous research demonstrating that homeless PWID are more likely to inject in public spaces 43 ; and that public injecting is associated with frequent and hasty injecting and the sharing of injecting equipment. 38,43,86,87 Homelessness among PWID leads to their spending more time in environments where risk behavior is elevated 87 and, consequently, BBV acquisition is more likely. 43,57 It follows that stable and affordable housing should decrease injecting risk behaviors among PWID, which may in turn reduce the risks of BBV transmission.…”

Injecting drug use and unstable housing: Scope for structural interventions in harm reduction

“…The public injecting environment in particular has been noted as a mediator of elevated health risk as a consequence of a lack of privacy, hygiene and amenity, and a fear of interruption, police attention or public exposure, which may result in hurried injections in which safety routines are sidelined 9,10,17,18,19,20 . A number of cohort studies associate higher levels of health risk behaviour with drug injection in public or street injecting locations 16,20,21,22 .…”

“…Unstable housing intersects with elevated risk of blood-borne infections associated with drug injection 10,27,41,42,43,44 . For example, in a multi-site study among over 1,000 injectors in England, those with recent experience of homelessness or temporary accommodation had almost twice the odds of HCV positivity 42,45 .…”

“…There is close overlap between public injecting, the use of public injecting environments and homelessness 23,24,25,26 . Surveys in the UK show over 50% IDUs report injecting in a public place within the last week 10,27,28 , with public injecting positively associated with homelessness and unstable housing 28 .…”

“…The drug injecting risk environment comprises the interplay of physical and social environment 2 . There has been increased interest in particular in how the micro physical settings of drug injection -such as 'shooting galleries', 'public injecting environments' and prisons -act as environmental determinants of health risk among injecting drug users (IDUs) 6,7,8,9,10,11 . Studies show the micro injecting environment to be a determinant of health risk, including regarding abscesses, vein damage, needle and syringe sharing, HCV infection and overdose 12,13,14,15,16 .…”