Syringe disposal among people who inject drugs before and after the implementation of a syringe services program.
Harry Levine, Tyler S Bartholomew, Victoria Rea-Wilson, Jason Onugha, David Jonathon Arriola, Gabriel Cardenas, David W Forrest, Alex H Kral, Lisa R Metsch, Emma Spencer, Hansel Tookes
Author Information
Harry Levine: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA.
Tyler S Bartholomew: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA.
Victoria Rea-Wilson: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA.
Jason Onugha: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA.
David Jonathon Arriola: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA.
Gabriel Cardenas: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA.
David W Forrest: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA.
Alex H Kral: RTI International, 351 California Street, Suite 500, San Francisco, CA, 94104, USA.
Lisa R Metsch: Department of Sociomedical Sciences, Columbia University, 2970 Broadway, New York, NY, 10027, USA.
Emma Spencer: Bureau of Communicable Diseases, Florida Department of Health, 4052 Bald Cypress Way, Tallahassee, FL, 32399, USA.
Hansel Tookes: Department of Medicine, University of Miami, 1120 NW 14thSt., Miami, FL, 33136, USA. Electronic address: hetookes@med.miami.edu.
INTRODUCTION: Due to the increase in people who use opioids in the US, there has been a steady increase in injection drug use. Without access to safe syringe disposal locations, people who inject drugs (PWID) have few options other than improper disposal, including in public places. In 2016, Florida's first legal Syringe Services Program (SSP) was established in Miami. This study aims to compare syringe disposal practices among PWID before and after the implementation of an SSP. METHODS: Visual inspection walkthroughs of randomly selected census blocks in the neighborhoods in the top quartile of narcotics-related arrests were conducted to assess improperly discarded syringes. Syringe location was geocoded in ArcGIS. Adult PWID pre-SSP (n = 448) and post-SSP (n = 482) implementation were recruited for a survey using respondent-driven sampling in Miami. A Poisson regression model was used to determine the adjusted relative risk (aRR) of improper syringe disposal pre- and post-SSP. RESULTS: A total of 191 syringes/1000 blocks were found post-implementation versus 371/1000 blocks pre-implementation, representing a 49% decrease after SSP implementation. In the surveys, 70% reported any improper syringe disposal post-SSP implementation versus 97% pre-SSP implementation. PWID in the post-implementation survey had 39% lower adjusted relative risk (aRR = 0.613; 95% CI = 0.546, 0.689) of improper syringe disposal as compared to pre-implementation. CONCLUSIONS: There was a significant decrease in the number of improperly discarded syringes in public in Miami after the implementation of an SSP. Providing PWID with proper disposal venues such as an SSP could decrease public disposal in other communities.
