Safe and unsafe spaces: Non-fatal overdose, arrest, and receptive syringe sharing among people who inject drugs in public and semi-public spaces in Baltimore City

Abstract

The spaces in which drug use occurs constitutes a key aspect of the "risk environment" of people who inject drugs (PWID). We aimed to add nuance to the characterization of "safe" and "unsafe" spaces in PWID's environments to further understand how these spaces amplify the risk of morbidities associated with injection drug use. PWID were recruited through the Baltimore City syringe service program and through peer referral. Participants completed a socio-behavioral survey. Multivariable logistic regression was used to identify associations between utilization of public, semi-public and private spaces with arrest, non-fatal overdose, and receptive syringe sharing. The sample of PWID (N = 283) was mostly 45 years and older (54%), male (69%), Black (55%), and heroin users (96%). Compared to PWID who primarily used private settings, the adjusted odds of recent overdose were greater among PWID who mostly used semi-public and public locations to inject drugs. We also found independent associations between arrest and semi-public spaces, and between receptive syringe sharing and public spaces (all p < 0.05). This study highlights the need for safe spaces where PWID can reduce their risk of overdose, likelihood of arrest and blood-borne diseases, and the dual potential of the environment in promoting health and risk.

Fentanyl-contaminated drugs and non-fatal overdose among people who inject drugs in Baltimore, MD

“…Finally, we observed that non-fatal overdose was higher among homeless PWID compared to PWID with stable housing, speaking to the importance of attending to the structural vulnerability of this population and their direct impacts on overdose [ 12 , 30 ]. We found that homelessness was also strongly associated with public injecting (e.g., injecting on the street or in a public bathroom), an association that we have examined further [ 31 ]. It is known that homelessness is associated with a range of negative health outcomes among PWID including injection risk behaviors [ 12 , 32 ].…”

Trends in opioid initiation among people who use opioids in three US cities

“…The survey ascertained sociodemographic data (age, race, gender, employment and housing status), current substance use, including recent (past 6 months) illicit fentanyl use and preference, habits surrounding use (route of administration, drug use setting) and overdose history. Questions were adapted from previous work . Employment was defined as full or part‐time employment, excluding illicit income‐generation which pays ‘under the table’ or ‘off the books’, and involvement in the drug or sex trade.…”

Willingness to Use Safe Consumption Spaces among Opioid Users at High Risk of Fentanyl Overdose in Baltimore, Providence, and Boston

“…The survey also included items on rushing drug purchases, preparation or use due to policing (past year), settings where drugs were usually used (past 30 days), and using drugs alone. Drug use setting [26] was modeled after our previous work: public spaces for drug use were defined as using in a street or park; semi-public spaces were defined as building stairwells, abandoned buildings, public restrooms, in a vehicle, and at a shooting gallery; and private spaces were in the participant's home or somebody else's home. The survey ascertained any access to a variety of health services in the past 6 months (emergency room, drug treatment, health care provider, and SSP), whether they currently had naloxone, and interest in using fentanyl test strips (FTS).…”