Editing Needle sharing

{{short description|Practice of intravenous drug-users}}
'''Needle sharing''' is the practice of intravenous drug-users by which a needle or [[syringe]] is shared by multiple individuals to administer [[intravenous drug]]s such as heroin, steroids, and hormones.<ref>{{Cite web|url=https://www.avert.org/hiv-transmission-prevention/injecting-drugs|title=Sharing needles to inject drugs, and HIV|date=2015-06-23|website=Avert|language=en|access-date=2019-11-14}}</ref> This is a primary vector for [[Blood-borne disease|blood-borne diseases]] which can be transmitted through blood (blood-borne pathogens).<ref name=":2">{{Cite web|url=https://www.cdc.gov/policy/hst/hi5/cleansyringes/index.html|title=Access to clean syringes {{!}} Health Impact in 5 Years {{!}} Health System Transformation {{!}} AD for Policy {{!}} CDC|date=2019-07-01|website=www.cdc.gov|language=en-us|access-date=2019-11-14}}</ref> People who inject drugs (PWID) are at an increased risk for [[Hepatitis C]] (HCV) and [[HIV]] due to needle sharing practices.<ref>{{Cite web|url=https://www.who.int/hiv/topics/idu/en/|title=People who inject drugs|website=World Health Organization|language=en-GB|access-date=2017-10-31}}</ref> From 1933 to 1943, [[Plasmodium falciparum|malaria]] was spread between users in the [[New York City]] area by this method. Afterwards, the use of [[quinine]] as a [[cutting agent]] in drug mixes became more common.<ref>{{cite book|last=Helpern|first=Milton | name-list-style = vanc |title=Autopsy : the memoirs of Milton Helpern, the world's greatest medical detective|year=1977|publisher=St. Martin's Press|location=New York|isbn=978-0-312-06211-8|pages=70–71|chapter=An Epidemic of Sorts}}</ref> Harm reduction efforts including safe disposal of needles, [[Supervised injection site|supervised injection sites]], and public education may help bring awareness on safer needle sharing practices.

==Infections==
Blood-borne diseases are transmitted when a susceptible person uses a needle that was previously used by a person who is infected with these pathogens; hence, sharing needles with other individuals is not a safe practice.<ref>[http://www.bbc.co.uk/worldservice/sci_tech/features/health/sexualhealth/aids/needle.shtml "Sharing Needles"], ''BBC''</ref> It takes one simple prick of a contaminated needle to put someone at risk of acquiring [[Hepatitis B]], Hepatitis C, or HIV infections with Hepatitis B being the easiest to contract, followed by Hepatitis C then HIV.<ref name=":1" /> People who use previously used needles are at increased risk of getting infected with blood-borne pathogens such as HIV, [[Hepatitis B virus|HBV]], and [[Hepatitis C virus|HCV]], and spreading the infections to others.<ref name="fda.gov">{{cite web|url=https://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/Sharps/default.htm|archive-url=https://web.archive.org/web/20111109160453/http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/Sharps/default.htm|url-status=dead|archive-date=November 9, 2011|title=Safely Using Sharps (Needles and Syringes) at Home, at Work and on Travel|website=[[Food and Drug Administration]] |date=2019-06-15}}</ref> In addition to HIV, HBV, and HCV, some [[Sexually transmitted infection|sexually transmitted infections]] (STIs) can be transmitted to uninfected individuals due to the risky injection practices.<ref>{{cite journal | vauthors = Fu R, Gutfraind A, [[Margaret Brandeau|Brandeau ML]] | title = Modeling a dynamic bi-layer contact network of injection drug users and the spread of blood-borne infections | journal = Mathematical Biosciences | volume = 273 | pages = 102–13 | date = March 2016 | pmid = 26775738 | pmc = 5154253 | doi = 10.1016/j.mbs.2016.01.003 }}</ref> 

According to [[Centers for Disease Control and Prevention|CDC]], in 2013, sharing syringes was the cause of HIV infection in 3,096 out of the 47,352 patients who were newly diagnosed with the disease in the United States.<ref name=":2" /> According to a study done by New Haven Connecticut's needle exchange program, 67.5% of the needles returned to the facility were contaminated with HIV.<ref name="pmid1403641">{{cite journal | vauthors = Kaplan EH, Heimer R | title = A model-based estimate of HIV infectivity via needle sharing | journal = Journal of Acquired Immune Deficiency Syndromes | volume = 5 | issue = 11 | pages = 1116–8 | year = 1992 | pmid = 1403641 }}</ref> Their assumption was that people bringing in “street needles” were shared among other people prior to bringing them to the program.<ref name="pmid1403641" /> Almost 50% of people who participate in IVDU have Hepatitis C.<ref>{{cite journal | vauthors = Platt L, Minozzi S, Reed J, Vickerman P, Hagan H, French C, Jordan A, Degenhardt L, Hope V, Hutchinson S, Maher L, Palmateer N, Taylor A, Bruneau J, Hickman M | display-authors = 6 | title = Needle syringe programmes and opioid substitution therapy for preventing hepatitis C transmission in people who inject drugs | journal = The Cochrane Database of Systematic Reviews | volume = 2017 | pages = CD012021 | date = September 2017 | issue = 9 | pmid = 28922449 | pmc = 5621373 | doi = 10.1002/14651858.CD012021.pub2 | url = http://www.cochrane.org/CD012021/ADDICTN_interventions-reducing-hepatitis-c-infection-people-who-inject-drugs | author-link11 = Lisa Maher }}</ref> Not only are blood borne diseases passed via needle sharing, but so are bacterial infections that can ultimately cause [[sepsis]].<ref name=":1">{{Cite web | url=https://www.who.int/mediacentre/factsheets/fs253/en/ | title=Health-care waste}}</ref> Additionally, improper disposal of hospital needles can expose [[Drug resistance|drug resistant]] organisms to the outside environment.<ref>{{cite journal | vauthors = Fernandes RM, Cary M, Duarte G, Jesus G, Alarcão J, Torre C, Costa S, Costa J, Carneiro AV | display-authors = 6 | title = Effectiveness of needle and syringe Programmes in people who inject drugs - An overview of systematic reviews | journal = BMC Public Health | volume = 17 | issue = 1 | pages = 309 | date = April 2017 | pmid = 28399843 | pmc = 5387338 | doi = 10.1186/s12889-017-4210-2 | doi-access = free }}</ref>

== Risk factors for needle sharing ==
Much research has been done on risk factors that may predispose an individual to needle sharing in an effort to improve the effectiveness of [[Needle exchange programme|needle-exchange programs]] (NEPs) and other harm reduction programs for PWID.<ref name=":0">{{Cite news|url=https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/people-inject-drugs|title=People who inject drugs, HIV and AIDS|date=2015-07-20|work=AVERT|access-date=2017-11-15|language=en}}</ref> The barriers that contribute to rates of needle sharing include the lack of accessibility to clean needles and education about safe needle usage.<ref name=":0" /> In each respective country, government and cultural views towards PWID and NEPs have an impact on the resources available as demonstrated by studies done in China,<ref>{{cite journal | vauthors = Chen X, Zhu L, Zhou YH, Liu FL, Li H, Yao ZH, Duo L, Pang W, Ye M, Zheng YT | display-authors = 6 | title = Factors associated with needle sharing among people who inject drugs in Yunnan, China: a combined network and regression analysis | journal = Infectious Diseases of Poverty | volume = 5 | issue = 1 | pages = 73 | date = August 2016 | pmid = 27502491 | pmc = 4977866 | doi = 10.1186/s40249-016-0169-y | doi-access = free }}</ref> France,<ref>{{cite journal | vauthors = Guichard A, Guignard R, Lert F, Roy E | title = Risk Factors Associated with Unsafe Injection Practices at the First Injection Episode among Intravenous Drug Users in France: Results from PrimInject, an Internet Survey | journal = Journal of Addiction | volume = 2015 | pages = 507214 | date = 2015 | pmid = 26504609 | pmc = 4609460 | doi = 10.1155/2015/507214 | doi-access = free }}</ref> Vietnam,<ref>{{cite journal | vauthors = Hien NT, Giang LT, Binh PN, Devillé W, van Ameijden EJ, Wolffers I | title = Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam | journal = Journal of Substance Abuse | volume = 13 | issue = 1–2 | pages = 45–58 | date = 2001 | pmid = 11547623 | doi = 10.1016/S0899-3289(01)00059-1 | url = https://www.nivel.nl/nl/publicaties/2803 }}</ref> and India.<ref>{{cite journal | vauthors = Chakrapani V, Newman PA, Shunmugam M, Dubrow R | title = Social-structural contexts of needle and syringe sharing behaviours of HIV-positive injecting drug users in Manipur, India: a mixed methods investigation | journal = Harm Reduction Journal | volume = 8 | issue = 1 | pages = 9 | date = May 2011 | pmid = 21569478 | pmc = 3120658 | doi = 10.1186/1477-7517-8-9 | doi-access = free }}</ref> Within the United States, needle sharing behavior is positively correlated to individuals who are of lower socioeconomic status, younger than 45 years old, male, and unemployed.<ref name="pmid8203687">{{cite journal | vauthors = Mandell W, Vlahov D, Latkin C, Oziemkowska M, Cohn S | title = Correlates of needle sharing among injection drug users | journal = American Journal of Public Health | volume = 84 | issue = 6 | pages = 920–3 | date = June 1994 | pmid = 8203687 | pmc = 1614968 | doi = 10.2105/ajph.84.6.920 }}</ref> The incidence of needle sharing was found to be more prevalent in homosexual and bisexual men compared to women and heterosexual men, particularly in minority communities.<ref name="pmid8203687" /> People of a minority race or ethnicity are often at an increased risk of needle sharing, possibly due to lower levels of health education.<ref name=":0" />

==Safe disposal of needles==

Discarding needles in regular household trash bins endangers children, pets, janitors, and waste management services personnel; therefore, needles should be properly disposed of in a FDA-cleared sharps container that is both puncture- and leak-resistant.<ref name="fda.gov" /> It is important to properly dispose of used needles because it can be difficult to tell if a needle has ever been used before.  By not disposing of needles in a safe way, users may expose others or themselves to a [[Needlestick injury|needle stick injury]].<ref name="pmid19252703">{{cite journal|date=March 2008|title=Needle stick injuries|journal=Paediatrics & Child Health|volume=13|issue=3|pages=211–20|doi=10.1093/pch/13.3.211|pmc=2529414|pmid=19252703}}</ref> If a sharps container is not available, needles can often be brought to local law enforcement, hospitals, or drug stores for safe collection and disposal. In addition, needles can be mailed in specialized containers to a mail-back program for safe disposal.<ref>{{cite web|url=https://www.epa.gov/sites/production/files/2016-02/documents/med-govt_0.pdf|title=Community Options for Safe Needle Disposal}}</ref> Moreover, needles can be utilized and disposed of properly in [[Supervised injection site|supervised injection sites]]. In the health care setting, use of blunt-end needles can minimize the risk of needle stick injuries.<ref>{{cite journal|vauthors=Parantainen A, Verbeek JH, Lavoie MC, Pahwa M|date=November 2011|title=Blunt versus sharp suture needles for preventing percutaneous exposure incidents in surgical staff|journal=The Cochrane Database of Systematic Reviews|volume=2016 |issue=11|pages=CD009170|doi=10.1002/14651858.CD009170.pub2|pmid=22071864|pmc=7387125}}</ref> 

== Harm reduction ==
NEPs, also known as syringe exchange programs (SEPs), are a form of [[harm reduction]] policy that provide new needles to persons addicted to drugs in exchange for used ones in order to help control the spread of disease.<ref>{{Cite web|url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5945a4.htm/Syringe-Exchange-Programs-United-States-2008|title=Syringe Exchange Programs --- United States, 2008|website=www.cdc.gov|access-date=2019-11-14}}</ref> In the [[United States]], there are three distinct prohibitions on needle exchange programs at the federal level—the [[Ryan White CARE Act]], the [[Substance Abuse and Mental Health Services Administration]] (SAMHSA) authorization,<ref>{{cite web|url=http://baltimorehealth.org/nep.html|title=Needle Exchange Program|last=Clemons|first=Thomas|name-list-style=vanc}}</ref> and the 1997 Labor-Health and [[Human Services]] (HHS) Education appropriations legislation. However, many states still provide the service despite the federal legislation, especially in large cities where intravenous drug use is a major health concern. A study in New York State found that during the course of 12 months, NEP prevented roughly 87 infections of [[HIV]] by preventing needle sharing. In addition, NEP have decreased the spread of HIV by one third to two fifths.<ref>{{cite web|url=https://www.aclu.org/drug-law-reform/needle-exchange-programs-promote-public-safety|title=Needle Exchange Programs Promote Public Safety}}</ref>

One of the other harm reduction measurements in this regard is the [[Supervised injection site|Supervised Injection Sites]], also known as Safe Injection Sites. In these facilities, drug users have access to new needles and they can use substances under the supervision of staff trained to prevent and treat drug overdose and trained to prevent HIV and hepatitis. Some of these sites also provide help to their clients to ease their access to drug treatment and other additional social and medical services. <ref>{{cite web |url= https://www.yestoscscalifornia.org/theissue |title=THE ISSUE |website=YES TO SCS CALIFORNIA |language=en-US |access-date=2019-10-24 }}</ref> There are some countries around the world that have already established safe injection sites, including Australia and Canada. According to [[NPR]], since the start of this program in Canada in 2013, these sites have supervised over 3.6 million injections and have prevented more than 6,000 overdoses. <ref>{{cite web |url= https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-the-evidence-that-supervised-drug-injection-sites-save-lives |title=What's The Evidence That Supervised Drug Injection Sites Save Lives? |website=NPR.org |date=7 September 2018 |language=en |access-date=2019-10-31 |last1=Gordon |first1=Elana }}</ref> Additionally, in a cross-sectional survey performed in Glasgow from 1990 to 1996, the incidence of Hepatitis C had significantly decreased with the implementation of safe needle exchanges.<ref>{{cite journal | vauthors = Taylor A, Goldberg D, Hutchinson S, Cameron S, Gore SM, McMenamin J, Green S, Pithie A, Fox R | display-authors = 6 | title = Prevalence of hepatitis C virus infection among injecting drug users in Glasgow 1990-1996: are current harm reduction strategies working? | journal = The Journal of Infection | volume = 40 | issue = 2 | pages = 176–83 | date = March 2000 | pmid = 10841096 | doi = 10.1053/jinf.2000.0647 }}</ref>

The progression of supervised injection site implementation is currently not widely accepted due to social stigma, lack of government support, and health advocacy. Continued public health education, advocacy efforts, and further research may help encourage the expansion supervised injection sites.<ref>{{cite journal | vauthors = Kerr T, Mitra S, Kennedy MC, McNeil R | title = Supervised injection facilities in Canada: past, present, and future | journal = Harm Reduction Journal | volume = 14 | issue = 1 | pages = 28 | date = May 2017 | pmid = 28521829 | pmc = 5437687 | doi = 10.1186/s12954-017-0154-1 | doi-access = free }}</ref>

==See also==
* [[Contaminated currency]]
* [[Needle and syringe programmes]]

== References ==
{{Reflist}}

==Sources==
*[https://web.archive.org/web/20110927064721/http://www.islandcounty.net/health/NEP_FAQ.htm Needle Exchange Program FAQ]
* {{cite journal | vauthors = Helpern M |date=March 30, 1934|title=Malaria among drug addicts in New York City - An epidemic of estivo-autumnal and quartan malaria among drug addicts in New York City transmitted by contaminated hypodermic syringes|journal=Public Health Reports|volume=49|issue=13|doi=10.2307/4581127|page=421|jstor=4581127}} Reprinted as {{cite journal |pmid=19313398|pmc=1440553|pages=477–479 | volume=91|issue=5|title=Malaria among drug addicts in New York City (March 30, 1934): An epidemic of aestivo-autumnal and quartan malaria among drug addicts in New York City transmitted by the use of contaminated hypodermic syringes|year=1976|author=Helpern M|journal=Public Health Reports}}

{{Drug use}}

{{DEFAULTSORT:Needle sharing}}
[[Category:Drug culture]]
[[Category:Infection-control measures]]