Harm Reduction Services Less Available in Areas Plagued by Rising IV Drug Use and HIV Infections
Access to harm reduction programs such as syringe exchange is lowest in rural and suburban areas, where rates of addiction to heroin and other opioids are on the rise, according to a study led by researchers at the Icahn School of Medicine at Mount Sinai and published online today in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
Over the last decade, there has been an increase in drug injection in the United States, primarily the injection of prescription opioids and heroin among persons who started opioid use with oral analgesics before transitioning to injecting. Syringe service programs (SSPs) allow people who inject drugs to exchange used needles and syringes for new, sterile needles and syringes. These programs reduce the chances that people who inject drugs will share injection equipment and thereby contract infections like HIV and hepatitis C. Many SSPs also distribute a medication called naloxone, which is proven to reverse opiate overdoses.
Researchers assessed the landscape and availability of syringe service programs across the United States, finding that 69 percent of SSPs surveyed were located in urban areas, leaving only 20 percent in rural areas and 9 percent in suburban locations. The findings indicate that harm reduction services are lacking for people in communities where they are often needed most. A recent study published in the Journal of Urban Health reports that half of all IV drug users live outside of major urban areas. The range of services offered at SSPs also varied by region. For example, only 37 percent of programs surveyed in rural areas offered naloxone, compared to 61 percent of urban programs that provided this service.
“Syringe service programs have been very effective in reducing HIV transmission in the U.S. and throughout the world,” said Don Des Jarlais, PhD, Professor of Psychiatry and Preventive Medicine, Icahn School of Medicine at Mount Sinai and lead author of the study. “Our data show that rural and suburban SSPs face some special challenges in recruiting clients, funding, and staffing, but that these programs can provide the needed services when they are implemented. The biggest problem is simply that we do not have enough of them in rural and suburban areas. State and local governments can save lives by extending these programs.”
One of the most highly reported recent epidemics of new HIV infections resulting from injection drug use was in southeastern Indiana. Until Indiana Governor Mike Pence declared the HIV outbreak a public health emergency in the spring of 2015, syringe exchange programs were illegal in the state.
"Over the last 20 years, syringe service programs have proven to be very potent weapons in the fight against HIV/AIDS,” said Ann Nugent, Senior Research Associate, Baron Edmond de Rothschild Chemical Dependency Institute at Mount Sinai Beth Israel and co-author of the study. “The challenge today is to extend the life-saving benefits of syringe exchange programs to all persons who need them--regardless of where they live."
The study was sponsored by the American Foundation for AIDS Research. Additional collaborators include researchers from the North American Syringe Exchange Network and the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, a division of the CDC.
About the Mount Sinai Health System
The Mount Sinai Health System is New York City's largest integrated delivery system, encompassing eight hospitals, a leading medical school, and a vast network of ambulatory practices throughout the greater New York region. Mount Sinai's vision is to produce the safest care, the highest quality, the highest satisfaction, the best access and the best value of any health system in the nation. The Health System includes approximately 7,480 primary and specialty care physicians; 11 joint-venture ambulatory surgery centers; more than 410 ambulatory practices throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and 31 affiliated community health centers. The Icahn School of Medicine is one of three medical schools that have earned distinction by multiple indicators: ranked in the top 20 by U.S. News & World Report's "Best Medical Schools", aligned with a U.S. News & World Report's "Honor Roll" Hospital, No. 12 in the nation for National Institutes of Health funding, and among the top 10 most innovative research institutions as ranked by the journal Nature in its Nature Innovation Index. This reflects a special level of excellence in education, clinical practice, and research. The Mount Sinai Hospital is ranked No. 18 on U.S. News & World Report's "Honor Roll" of top U.S. hospitals; it is one of the nation's top 20 hospitals in Cardiology/Heart Surgery, Gastroenterology/GI Surgery, Geriatrics, Nephrology, and Neurology/Neurosurgery, and in the top 50 in six other specialties in the 2018-2019 "Best Hospitals" issue. Mount Sinai's Kravis Children's Hospital also is ranked nationally in five out of ten pediatric specialties by U.S. News & World Report. The New York Eye and Ear Infirmary of Mount Sinai is ranked 11th nationally for Ophthalmology and 44th for Ear, Nose, and Throat. Mount Sinai Beth Israel, Mount Sinai St. Luke's, Mount Sinai West, and South Nassau Communities Hospital are ranked regionally.